Effectiveness of rivaroxaban for thromboprophylaxis of prosthetic heart valves in a porcine heterotopic valve model

Greiten, Lawrence; McKellar, Stephen H.; Rysavý, J; Schaff, Hartzell V.

doi:10.1093/ejcts/ezt545

Cited by 36 publications

(20 citation statements)

References 26 publications

(33 reference statements)

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“…In vitro and animal models have shown promising results in the efficacy of rivaroxaban as thromboprophylaxis in MHV [ 27 , 28 ]. Recently, we reported promising results from the first experience of a Factor Xa inhibitor (rivaroxaban) in humans, where we followed seven patients with MHV over 3 months [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of the New Oral Anticoagulants and Warfarin in Patients with Atrial Fibrillation and Valvular Heart Disease: Systematic Review and Meta-Analysis

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et al. 2019

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Introduction New oral anticoagulants (NOACs) are approved for use in nonvalvular atrial fibrillation (AF). Objectives This study aimed to evaluate the efficacy and safety of NOACs compared with warfarin in AF and valvular heart disease (VHD). Methods We identified randomized controlled trials (RCTs) and post-hoc analyses comparing NOACs and warfarin in AF and VHD, including biological and mechanical heart valves (MHV). Through systematic review and meta-analysis, with the aid of the “Rev Man” program 5.3, the primary effectiveness endpoints were stroke and systemic embolism (SE). The primary safety outcome was major bleeding, and the secondary outcome included intracranial hemorrhage. Data were analyzed using risk ratios (RRs) and 95% confidence intervals (CIs), and heterogeneity was assessed using the I 2 statistic. Results Six RCTs were included, involving 13,850 patients with AF and VHD. NOACs significantly reduced the risk of stroke/SE (RR 0.78; 95% CI 0.66–0.91; P = 0.002) and intracranial hemorrhage (RR 0.51; 95% CI 0.33–0.79; P = 0.003) and lowered the risk of major bleeding (RR 0.77; 95% CI 0.58–1.02; P = 0.07) compared with warfarin. Conclusions The efficacy and safety of NOACs as thromboprophylaxis for AF and VHD are similar to those of warfarin. Electronic supplementary material The online version of this article (10.1007/s40268-019-0274-z) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Comparison of the New Oral Anticoagulants and Warfarin in Patients with Atrial Fibrillation and Valvular Heart Disease: Systematic Review and Meta-Analysis

Bitar

Neto

Filho³

et al. 2019

Drugs R D

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“…Thus, while the prohibition of dabigatrin was expanded to the general class of NOACs, no current clinical data regarding the fXa inhibitors has been published. In fact there is early evidence that rivaroxaban is more effective than enoxaparin at preventing porcine thrombosis [25]. Yet this must be considered preliminary and it is not known at this point in time whether either rivaroxaban or apixaban is protective and different from dabigatrin.…”

Section: Issn: 2476-230xmentioning

confidence: 99%

Valvular Heart Disease And “Nonvalvular Atrial Fibrillation” Coumadin or a Novel Oral Anticoagulant Variables to Consider

2018

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Clinicians treating atrial fibrillation must initially identify and ultimately verify whether this rhythm fits within the definition of “non-valvular” atrial fibrillation (NVAF). The spectrum of structural heart disease can render this process a challenge as what is meant by NVAF is continually evolving. Phenotypic variants in valvular heart disease including repaired valvular injury have undergone definitional updates pertaining to NVAF. This has produced inconsistencies in each subsequent authoritative guideline often further confusing practitioners. At issue is whether a vitamin K dependent antagonist (VKA) exemplified by warfarin, or one of the new novel oral anticoagulants (NOACs) is appropriate to treat NVAF in a patient with a form of valvular heart disease. The present effort is a practical review of the current clinical landscape wherein practitioners struggle to advise and treat patients with optimal anticoagulation therapy with NVAF as currently defined. It is also a review of why certain valvular conditions may actually still fit within the definition of NVAF allowing NOAC use.

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“…47 Similar findings were made in an earlier animal study that suggested that rivaroxaban might be superior to standard therapy after mechanical valve surgery in terms of valve thrombus and platelet deposition. 48 Unexpected results came also from the Re-Align study, that aimed to investigate dabigatran in patients after mechanical heart valve surgery. Increased rates of thromboembolic and bleeding complications compared with VKA regimen were observed.…”

Section: Factor Xa Inhibitorsmentioning

confidence: 99%

Noncanonical Effects of Oral Thrombin and Factor Xa Inhibitors in Platelet Activation and Arterial Thrombosis

et al. 2020

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Nonvitamin K oral anticoagulants (NOACs) or direct oral anticoagulants comprise inhibitors of factor Xa (rivaroxaban, apixaban, edoxaban) or factor IIa (dabigatran). Both classes efficiently interfere with the final or penultimate step of the coagulation cascade and showed superior net clinical benefit compared with vitamin K antagonists for prevention of thromboembolic events in patients with AF and for prevention and therapy of deep vein thrombosis and pulmonary embolism. None the less, accumulating data suggested, that there may be differences regarding the frequency of atherothrombotic cardiovascular events between NOACs. Thus, the optimal individualized NOAC for each patient remains a matter of debate. Against this background, some basic and translational analyses emphasized NOAC effects that impact on platelet activity and arterial thrombus formation beyond inhibition of plasmatic coagulation. In this review, we will provide an overview of the available clinical and translational evidence for so-called noncanonical NOAC effects on platelet activation and arterial thrombosis.

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Effectiveness of rivaroxaban for thromboprophylaxis of prosthetic heart valves in a porcine heterotopic valve model

Cited by 36 publications

References 26 publications

Comparison of the New Oral Anticoagulants and Warfarin in Patients with Atrial Fibrillation and Valvular Heart Disease: Systematic Review and Meta-Analysis

Comparison of the New Oral Anticoagulants and Warfarin in Patients with Atrial Fibrillation and Valvular Heart Disease: Systematic Review and Meta-Analysis

Valvular Heart Disease And “Nonvalvular Atrial Fibrillation” Coumadin or a Novel Oral Anticoagulant Variables to Consider

Noncanonical Effects of Oral Thrombin and Factor Xa Inhibitors in Platelet Activation and Arterial Thrombosis

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