{"id":22569,"date":"2022-09-29T04:12:00","date_gmt":"2022-09-28T20:12:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=22569"},"modified":"2022-09-29T07:45:39","modified_gmt":"2022-09-28T23:45:39","slug":"nejm%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e9%a3%8e%e6%b9%bf%e6%80%a7%e5%bf%83%e8%84%8f%e7%97%85%e7%9b%b8%e5%85%b3%e6%88%bf%e9%a2%a4%e7%9a%84%e5%88%a9%e4%bc%90%e6%b2%99%e7%8f%ad%e6%8a%97","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=22569","title":{"rendered":"[NEJM\u53d1\u8868\u8bba\u6587]\uff1a\u98ce\u6e7f\u6027\u5fc3\u810f\u75c5\u76f8\u5173\u623f\u98a4\u7684\u5229\u4f10\u6c99\u73ed\u6297\u51dd"},"content":{"rendered":"\n

ORIGINAL ARTICLE<\/a><\/p>\n\n\n\n

Rivaroxaban in Rheumatic Heart Disease\u2013Associated Atrial Fibrillation<\/h1>\n\n\n\n

Stuart J. Connolly, Ganesan Karthikeyan, Mpiko Ntsekhe,\u00a0et al<\/h3>\n\n\n\n

N Engl J Med August 28, 2022
DOI: 10.1056\/NEJMoa2209051<\/h3>\n\n\n\n

Abstract<\/h2>\n\n\n\n

BACKGROUND<\/h2>\n\n\n\n

Testing of factor Xa inhibitors for the prevention of cardiovascular events in patients with rheumatic heart disease\u2013associated atrial fibrillation has been limited.<\/p>\n\n\n\n

METHODS<\/h2>\n\n\n\n

We enrolled patients with atrial fibrillation and echocardiographically documented rheumatic heart disease who had any of the following: a CHA2<\/sub>DS2<\/sub>VASc score of at least 2 (on a scale from 0 to 9, with higher scores indicating a higher risk of stroke), a mitral-valve area of no more than 2 cm2<\/sup>, left atrial spontaneous echo contrast, or left atrial thrombus. Patients were randomly assigned to receive standard doses of rivaroxaban or dose-adjusted vitamin K antagonist. The primary efficacy outcome was a composite of stroke, systemic embolism, myocardial infarction, or death from vascular (cardiac or noncardiac) or unknown causes. We hypothesized that rivaroxaban therapy would be noninferior to vitamin K antagonist therapy. The primary safety outcome was major bleeding according to the International Society of Thrombosis and Hemostasis.<\/p>\n\n\n\n

RESULTS<\/h2>\n\n\n\n

Of 4565 enrolled patients, 4531 were included in the final analysis. The mean age of the patients was 50.5 years, and 72.3% were women. Permanent discontinuation of trial medication was more common with rivaroxaban than with vitamin K antagonist therapy at all visits. In the intention-to-treat analysis, 560 patients in the rivaroxaban group and 446 in the vitamin K antagonist group had a primary-outcome event. Survival curves were nonproportional. The restricted mean survival time was 1599 days in the rivaroxaban group and 1675 days in the vitamin K antagonist group (difference, \u221276 days; 95% confidence interval [CI], \u2212121 to \u221231; P<0.001). A higher incidence of death occurred in the rivaroxaban group than in the vitamin K antagonist group (restricted mean survival time, 1608 days vs. 1680 days; difference, \u221272 days; 95% CI, \u2212117 to \u221228). No significant between-group difference in the rate of major bleeding was noted.<\/p>\n\n\n\n

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CONCLUSIONS<\/h2>\n\n\n\n

Among patients with rheumatic heart disease\u2013associated atrial fibrillation, vitamin K antagonist therapy led to a lower rate of a composite of cardiovascular events or death than rivaroxaban therapy, without a higher rate of bleeding. (Funded by Bayer; INVICTUS ClinicalTrials.gov number, NCT02832544. opens in new tab<\/a>.)<\/p>\n","protected":false},"excerpt":{"rendered":"

ORIGINAL ARTICLE Rivaroxaban in Rheumatic Heart Disease […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/22569"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=22569"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/22569\/revisions"}],"predecessor-version":[{"id":22686,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/22569\/revisions\/22686"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=22569"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=22569"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=22569"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}