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Rivaroxaban in patients undergoing surgical mitral valve repair

Feridoun Noohi1,2, Parham Sadeghipour2,3, Sirous Kordrostami1

  • 1Heart Valve Diseases Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Vali-Asr Ave, 1995614331, Tehran, Iran.

Journal of Thrombosis and Thrombolysis
|February 1, 2020
PubMed

Insights

Rivaroxaban demonstrated safety and efficacy comparable to warfarin for anticoagulation after mitral valve repair (MVre). This study suggests rivaroxaban as a viable option, warranting further investigation in larger trials.

Area of Science:

  • Cardiology
  • Pharmacology
  • Surgical Innovation

Background:

  • Current guidelines recommend 3-month anticoagulation post-mitral valve repair (MVre).
  • Non-vitamin K antagonist oral anticoagulants (NOACs) role in MVre anticoagulation is understudied.
  • Warfarin is a traditional anticoagulant, while rivaroxaban is a NOAC.

Purpose of the Study:

  • To compare the safety and efficacy of rivaroxaban versus warfarin for anticoagulation in patients undergoing MVre.
  • To evaluate clinical outcomes including bleeding events and cerebrovascular accidents over a 1-year follow-up period.

Main Methods:

  • A mixed cohort study comparing prospective rivaroxaban data with retrospective warfarin data.
  • 736 patients undergoing MVre were initially recruited; 153 treated with rivaroxaban and 144 with warfarin were analyzed.
  • Propensity score matching was used to compare 104 patients in each group due to baseline dissimilarities.

Main Results:

  • No major bleeding or cerebrovascular accidents occurred in either group during the 1-year follow-up.
  • Clinically relevant non-major bleeding was infrequent and not significantly different between rivaroxaban (2 patients) and warfarin (4 patients) groups (P=0.407 post-matching).
  • Anticoagulant type did not significantly predict 1-year outcomes (HR 2.165, P=0.387).

Conclusions:

  • Rivaroxaban is a safe and effective anticoagulant option for patients undergoing mitral valve repair (MVre).
  • These findings support the use of rivaroxaban in this patient population.
  • Larger randomized controlled trials are recommended to confirm these preliminary results.
Keywords:
Antithrombotic regimenMitral valve repairNovel oral anticoagulation therapyRivaroxabanWarfarin

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