Vitamin K antagonist superior to DOAC in RHD with AF – INVICTUS study
Vitamin K antagonist superior to DOAC in RHD with AF – INVICTUS study
The INVICTUS program (INVestIgation of rheumatiC AF Treatment Using VKA) was designed as an open label parallel group trial comparing treatment with vitamin K antagonists or rivaroxaban, in rheumatic heart disease with atrial fibrillation [1]. It was an international multicentre randomized study. A registry of 17,000 patients was also planned to document the contemporary clinical course of patients with RHD, including a focused sub-study on pregnant women with RHD within the registry. RHD is considered as a neglected disease affecting 33 million people, mainly in low and middle income countries.
The study enrolled 4565 patients, of which 4531 were included in the final analysis [2]. Mean age was 50.5 years and 72.3% were women. It is interesting to note that permanent discontinuation of trial medication was more common with rivaroxaban than with vitamin K antagonist therapy at all visits. Echocardiographically documented rheumatic heart disease with atrial fibrillation and any of the following risk factors were included in the study:
CHA2DS2VASc score of at least 2
Mitral valve area of 2 sq. cm or less
Left atrial spontaneous echo contrast
Left atrial thrombus
The primary outcome assessed in the study was a composite of stroke, systemic embolism, myocardial infarction or death from vascular (cardiac or noncardiac) or unknown causes. The primary safety outcome assessed was major bleeding according to...
Source: Cardiophile MD - Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
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