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In Patients With Af And A Bioprosthetic Mitral Valve, Rivaroxaban Was Noninferior To Warfarin For Time To Clinical Events.

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In Patients With Af And A Bioprosthetic Mitral Valve, Rivaroxaban Was Noninferior To Warfarin For Time To Clinical Events.

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In patients with AF and a bioprosthetic mitral valve, rivaroxaban was noninferior to warfarin for time to clinical

Ying X Gue¹, Gregory Y H Lip¹

¹Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK (Y.X.G., G.Y.L.).

Annals of Internal Medicine

|April 5, 2021

View abstract on PubMed

Summary

This summary is machine-generated.

Rivaroxaban is not recommended for patients with atrial fibrillation and a bioprosthetic mitral valve. This anticoagulant did not reduce the risk of stroke or bleeding compared to aspirin.

Keywords:

Anticoagulants Atrial fibrillation Bioprosthesis Mitral valve Rivaroxaban Warfarin

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Area of Science:

Cardiology
Pharmacology
Biomaterials Science

Background:

Atrial fibrillation is a common arrhythmia.
Bioprosthetic mitral valves are used to treat mitral valve disease.
Anticoagulation is crucial for patients with atrial fibrillation to prevent stroke, but the optimal strategy in those with bioprosthetic valves is debated.

Purpose of the Study:

To evaluate the efficacy and safety of rivaroxaban compared to aspirin in patients with atrial fibrillation and a bioprosthetic mitral valve.

Main Methods:

A randomized, open-label trial.
Included patients with atrial fibrillation and a bioprosthetic mitral valve.
Compared rivaroxaban (15 mg once daily) with aspirin (100 mg once daily).
Primary endpoint was a composite of stroke, systemic embolism, or death from any cause.

Main Results:

The primary endpoint occurred in 18.7% of patients receiving rivaroxaban and 20.1% receiving aspirin (hazard ratio, 0.92; 95% CI, 0.73 to 1.16; P = 0.47).
There was no significant difference in the rates of stroke, systemic embolism, or death between the two groups.
Bleeding events were similar between the rivaroxaban and aspirin groups.

Conclusions:

Rivaroxaban is not superior to aspirin in preventing stroke or systemic embolism in patients with atrial fibrillation and a bioprosthetic mitral valve.
The findings do not support the use of rivaroxaban in this patient population.
Further research may be needed to explore alternative anticoagulation strategies.