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Anticoagulation for rheumatic mitral stenosis, INVICTUS in perspective.
1School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
Current Opinion in Cardiology
|January 31, 2023
Summary
For rheumatic mitral stenosis with atrial fibrillation, vitamin K antagonists (VKAs) are recommended over newer anticoagulants. The INVICTUS trial showed VKAs had lower event rates, including mortality, compared to rivaroxaban.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Rheumatic mitral stenosis (MS) remains a significant health issue in low-income countries.
- Nonvitamin-K antagonist oral anticoagulants (NOACs) are increasingly used for stroke prevention, but their role in rheumatic MS with atrial fibrillation (AF) is less understood.
Approach:
- This review synthesizes current anticoagulation guidelines for valvular heart disease.
- It specifically focuses on patients with rheumatic MS and AF, referencing the INVICTUS trial.
Key Points:
- The INVICTUS trial compared NOACs (rivaroxaban) with VKAs in ~4600 patients with moderate to severe rheumatic MS and AF.
- VKA-treated patients showed lower rates of stroke, systemic embolization, myocardial infarction, and death compared to rivaroxaban.
- Stroke rates in anticoagulated rheumatic MS patients are lower than previously thought.
Conclusions:
- Vitamin K antagonists (VKAs) are the current standard of care for moderate to severe rheumatic MS with AF.
- Non-stroke related deaths are the primary cause of mortality in these patients.
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