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Rivaroxaban in Patients Transitioned From Vitamin K Antagonist Therapy FREE

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The full report is titled “Clinical Outcomes With Rivaroxaban in Patients Transitioned From Vitamin K Antagonist Therapy. A Subgroup Analysis of a Randomized Trial.” It is in the 18 June 2013 issue of Annals of Internal Medicine (volume 159, pages 861-868). The authors are K.W. Mahaffey, D. Wojdyla, G.J. Hankey, H.D. White, C.C. Nessel, J.P. Piccini, M.R. Patel, S.D. Berkowitz, R.C. Becker, J.L. Halperin, D.E. Singer, R.M. Califf, K.A.A. Fox, G. Breithardt, and W. Hacke.

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Ann Intern Med. 2013;158(12):I-28. doi:10.7326/0003-4819-158-12-201306180-00001
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What is the problem and what is known about it so far?

Patients with atrial fibrillation can form blood clots in the heart that can break off and travel to other parts of the body, causing stroke or embolism. They are typically prescribed vitamin K antagonists (VKAs), such as warfarin, to make the blood less likely to clot. Patients receiving VKAs need regular monitoring to show that their blood clots less but not so much that serious bleeding episodes may occur. Several new drugs, including rivaroxaban, have recently been developed that also decrease blood clotting in patients with atrial fibrillation without the need for regular monitoring.

Why did the researchers do this particular study?

To see whether patients already receiving VKAs who continued therapy with such drugs had similar numbers of strokes, embolisms, and bleeding episodes as patients who switched to rivaroxaban.

Who was studied?

Patients in a clinical trial comparing VKAs and rivaroxaban who were already receiving and tolerating VKAs at study entry.

How was the study done?

Patients were randomly assigned to continue to receive VKAs with monitoring or to switch to rivaroxaban.

What did the researchers find?

Patients who switched to rivaroxaban were not more likely to have strokes or embolisms than those who continued VKA therapy. Patients receiving rivaroxaban were more likely to have bleeding episodes during the first week of therapy than those who continued VKA therapy. After 30 days of treatment, patients receiving VKAs had more bleeding episodes than those receiving rivaroxaban.

What were the limitations of the study?

The clinical trial was not designed specifically to study this type of patient and was not large enough to detect less common or rare adverse events.

What are the implications of the study?

For patients with atrial fibrillation, continuing VKA therapy or switching to rivaroxaban may both be reasonable choices. Patients should discuss their preferences and questions with their health care providers.





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