Vitamin K Antagonists- Study Shows Vitamin K Antagonist Therapy More Effective Than Rivaroxaban for Rheumatic Heart Disease Patients with Atrial Fibrillation
According to a new study published in the New England Journal of Medicine, vitamin K antagonist therapy may be more beneficial than rivaroxaban for patients suffering from rheumatic heart disease-associated atrial fibrillation.
The study included 4,565 patients with atrial fibrillation and echocardiographically documented rheumatic heart disease who had a CHA2DS2VASc score of at least 2, a mitral valve area no larger than 2 cm2, left atrial spontaneous echo contrast, or left atrial thrombus. They were randomly assigned to receive standard doses of rivaroxaban or an adjusted vitamin K antagonist.
The study’s primary efficacy outcome was a composite of stroke, systemic embolism, myocardial infarction or death from vascular or unknown causes.
The researchers hypothesized that rivaroxaban therapy would not be inferior to vitamin K antagonist therapy. According to the International Society of Thrombosis and Hemostasis’ primary safety outcome of major bleeding was also included in their analysis.
After analyzing the data, researchers discovered that vitamin K antagonist therapy led to a lower composite rate of cardiovascular events or death than rivaroxaban therapy without an increase in bleeding.
The survival curves were nonproportional; restricted mean survival time for both groups was 1599 days in one case and 1675 days for the vitamin K antagonist group (difference, -76 days; 95% confidence interval [CI], -121 to -31; P0.001).
Death incidence was higher among rivaroxaban group than in its counterpart (restricted mean survival time vs 1680 days; difference -72 days; 95% confidence interval [CI], -117 to -28).
The study’s results indicate that vitamin K antagonist therapy may be the more beneficial option for patients with rheumatic heart disease-associated atrial fibrillation. While rivaroxaban therapy is noninferior in terms of efficacy, vitamin K antagonist therapy could result in better survival and mortality outcomes.
This study was funded by Bayer and conducted by an international team of researchers from different institutions, such as McMaster University in Canada, Groote Schuur Hospital in South Africa, and the University of Zambia in Zambia.
In conclusion, this study emphasizes the significance of personalized treatment plans for patients with rheumatic heart disease-associated atrial fibrillation. Physicians should carefully take into account each patient’s medical history and risk factors when selecting an appropriate anticoagulant therapy.
Source- Connolly SJ, Karthikeyan G, Ntsekhe M, Haileamlak A, El Sayed A, El Ghamrawy A, Damasceno A, Avezum A, Dans AML, Gitura B, Hu D, Kamanzi ER, Maklady F, Fana G, Gonzalez-Hermosillo JA, Musuku J, Kazmi K, Zühlke L, Gondwe L, Ma C, Paniagua M, Ogah OS, Molefe-Baikai OJ, Lwabi P, Chillo P, Sharma SK, Cabral TTJ, Tarhuni WM, Benz A, van Eikels M, Krol A, Pattath D, Balasubramanian K, Rangarajan S, Ramasundarahettige C, Mayosi B, Yusuf S; INVICTUS Investigators. Rivaroxaban in Rheumatic Heart Disease-Associated Atrial Fibrillation. N Engl J Med. 2022 Sep 15;387(11):978-988. doi: 10.1056/NEJMoa2209051. Epub 2022 Aug 28. PMID: 36036525.
Tags: #sciencenews #VitaminKAntagonists #Rivaroxaban #AtrialFibrillation #RheumaticHeartDisease #CardiovascularPrevention #MedicalResearch #HeartHealth
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