Impact of polyvascular disease on patients with atrial fibrillation: Insights from ROCKET AF - 11/06/18
Abstract |
Background |
We investigated the impact of polyvascular disease in patients enrolled in ROCKET AF.
Methods |
Cox regression models were used to assess clinical outcomes and treatment effects of rivaroxaban compared with warfarin in patients with atrial fibrillation and coronary, peripheral, or carotid artery disease, or any combination of the 3.
Results |
A total of 655 (4.6%) patients had polyvascular disease (≥2 disease locations), and 3,391 (23.8%) had single–arterial bed disease. Patients with polyvascular disease had similar rates of stroke/systemic embolism but higher rates of cardiovascular and bleeding events when compared with those without vascular disease. Use of rivaroxaban compared with warfarin was associated with higher rates of stroke in patients with polyvascular disease (hazard ratio [HR] 2.41, 95% CI 1.05-5.54); however, this was not seen in patients with single-bed (HR 0.90, 95% CI 0.64-1.28) or no vascular disease (HR 0.85, 95% CI 0.69-1.04; interaction P = .058). There was a significant interaction for major or nonmajor clinically relevant bleeding in patients with polyvascular (HR 1.23, 95% CI 0.91-1.65) and single-bed vascular disease (HR 1.30, 95% CI 1.13-1.49) treated with rivaroxaban compared with warfarin when compared with those without vascular disease (HR 0.95, 95% CI 0.87-1.04; interaction P = .0006). Additional antiplatelet therapy in this population did not improve stroke or cardiovascular outcomes.
Conclusion |
The use of rivaroxaban compared with warfarin was associated with a higher risk of stroke and bleeding in patients with polyvascular disease enrolled in ROCKET AF. Further studies are needed to understand the optimal management of this high-risk population.
Le texte complet de cet article est disponible en PDF.Plan
| Kenneth Bilchick, MD, MS, served as guest editor for this article. |
|
| All listed authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation |
|
| Clinical Trials Registration: ClinicalTrials.gov (NCT00403767). |
Vol 200
P. 102-109 - juin 2018 Retour au numéro
Article précédent
- Clinical trials evaluating red blood cell transfusion thresholds: An updated systematic review and with additional focus on patients with cardiovascular disease
- Jeffrey L Carson, Simon J Stanworth, John H. Alexander, Nareg Roubinian, Dean A Fergusson, Darrell J Triulzi, Shaun G Goodman, Sunil V. Rao, Carolyn Doree, Paul C Hebert
- Randomized placebo controlled trial evaluating the safety and efficacy of single low-dose intracoronary insulin-like growth factor following percutaneous coronary intervention in acute myocardial infarction (RESUS-AMI)
- Noel M. Caplice, Mary C. DeVoe, Janet Choi, Darren Dahly, Theodore Murphy, Ernest Spitzer, Robert Van Geuns, Michael M. Maher, David Tuite, David M. Kerins, Mohammed T. Ali, Imtiaz Kalyar, Eoin F. Fahy, Wisam Khider, Peter Kelly, Peter P. Kearney, Ronan J. Curtin, Conor O’Shea, Carl J. Vaughan, Joseph A. Eustace, Eugene P. McFadden
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?