The INVICTUS rheumatic heart disease research program: Rationale, design and baseline characteristics of a randomized trial of rivaroxaban compared to vitamin K antagonists in rheumatic valvular disease and atrial fibrillation

Karthikeyan, Ganesan; Connolly, Stuart J.; Ntsekhe, Mpiko; Benz, Alexander P; Rangarajan, Sumathy; Lewis, Gayle; Yun, Yan; Sharma, Sanjib Kumar; Maklady, Fathi A.; Elghamrawy, Alaa Eldin; Kazmi, Khawar; Cabral, Tantchou Tchoumi Jacques; Hu, Dayi; Ma, Changsheng; Gitura, Bernard; Avezum, Álvaro; Zühlke, Liesl; Lwabi, Peter; Haileamlak, Abraham; Ogah, Okechukwu S; Chillo, Pilly; Paniagua, María; ElSayed, Ahmed; Dans, Antonio L.; Gondwe-Chunda, Lillian; Molefe-Baikai, Onkabetse Julia; González-Hermosillo, Jesús Antonio; Hakim, James; Damasceno, Albertino; Kamanzi, Emmanuel; Musuku, John; Davletov, Kairat; Connolly, Katherine; Mayosi, Bongani M.; Yusuf, Salim; Investigators, Invictus

doi:10.1016/j.ahj.2020.03.018

Cited by 47 publications

(33 citation statements)

References 22 publications

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“…This is a prospective, randomized, parallel-group, open-label clinical trial of rivaroxaban versus standard VKA therapy to evaluate non-inferiority of rivaroxaban to VKA, with testing for superiority if non-inferiority is satisfied. It is expected to be completed in 2022 [ 16 ]. Another randomized controlled clinical trial called RIvoraxaban in Mitral Stenosis (RISE MS) is currently recruiting patients with relevant MS (moderate or severe) and concomitant AF to evaluate safety and effectiveness of rivaroxaban management in comparison to warfarin in these patients.…”

Section: Discussionmentioning

confidence: 99%

Giant Left Atrial Thrombus Despite Anticoagulation with Apixaban in a Patient with Mitral Stenosis and Atrial Fibrillation

et al. 2021

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Section: Discussionmentioning

confidence: 99%

Giant Left Atrial Thrombus Despite Anticoagulation with Apixaban in a Patient with Mitral Stenosis and Atrial Fibrillation

et al. 2021

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“…The current recommendation of VKA for AF with RVHD produces continuing need for international normalized ratio (INR) testing, which can be problematic. There is a need for research on use of NOACs versus VKA in RVHD [ 165 ], given their non-inferiority in bioprosthetic valves [ 166 ]. Inclusion of point-of-care INR testing in OAC programs would avoid travel costs [ 27 167 168 ].…”

Section: Anticoagulant Therapy To Prevent Af-related Strokementioning

confidence: 99%

World Heart Federation Roadmap on Atrial Fibrillation – A 2020 Update

et al. 2021

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The World Heart Federation (WHF) commenced a Roadmap initiative in 2015 to reduce the global burden of cardiovascular disease and resultant burgeoning of healthcare costs. Roadmaps provide a blueprint for implementation of priority solutions for the principal cardiovascular diseases leading to death and disability. Atrial fibrillation (AF) is one of these conditions and is an increasing problem due to ageing of the world's population and an increase in cardiovascular risk factors that predispose to AF. The goal of the AF roadmap was to provide guidance on priority interventions that are feasible in multiple countries, and to identify roadblocks and potential strategies to overcome them.Since publication of the AF Roadmap in 2017, there have been many technological advances including devices and artificial intelligence for identification and prediction of unknown AF, better methods to achieve rhythm control, and widespread uptake of smartphones and apps that could facilitate new approaches to healthcare delivery and increasing community AF awareness.In addition, the World Health Organisation added the non-vitamin K antagonist oral anticoagulants (NOACs) to the Essential Medicines List, making it possible to increase advocacy for their widespread adoption as therapy to prevent stroke. These advances motivated the WHF to commission a 2020 AF Roadmap update. Three years after the original Roadmap publication, the identified barriers and solutions were judged still relevant, and progress has been slow.This 2020 Roadmap update reviews the significant changes since 2017 and identifies priority areas for achieving the goals of reducing death and disability related to AF, particularly targeted at low-middle income countries. These include advocacy to increase appreciation of the scope of the problem; plugging gaps in guideline management and prevention through physician education, increasing patient health literacy, and novel ways to increase access to integrated healthcare including mHealth and digital transformations; and greater emphasis on achieving practical solutions to national and regional entrenched barriers. Despite the advances reviewed in this update, the task will not be easy, but the health rewards of implementing solutions that are both innovative and practical will be great.

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“…Patients with rheumatic heart disease and those with mechanical valves are some who are being enrolled in clinical trials. 25,26 Until conclusive data are available on these patient subgroups, DOAC use is not indicated in these patients. The role of DOACs in transcatheter and surgical aortic and MV repair will be another important area for research trials.…”

Section: Discussionmentioning

confidence: 99%