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Rivaroxaban with or...
Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial.
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Anand, Sonia S (författare)
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Bosch, Jackie (författare)
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Eikelboom, John W (författare)
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Connolly, Stuart J (författare)
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Diaz, Rafael (författare)
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Widimsky, Peter (författare)
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Aboyans, Victor (författare)
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Alings, Marco (författare)
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Kakkar, Ajay K (författare)
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Keltai, Katalin (författare)
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Maggioni, Aldo P (författare)
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Lewis, Basil S (författare)
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Störk, Stefan (författare)
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Zhu, Jun (författare)
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Lopez-Jaramillo, Patricio (författare)
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O'Donnell, Martin (författare)
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Commerford, Patrick J (författare)
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Vinereanu, Dragos (författare)
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Pogosova, Nana (författare)
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- Ryden, Lars (författare)
- Karolinska Institutet
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Fox, Keith A A (författare)
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Bhatt, Deepak L (författare)
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Misselwitz, Frank (författare)
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Varigos, John D (författare)
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Vanassche, Thomas (författare)
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Avezum, Alvaro A (författare)
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Chen, Edmond (författare)
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Branch, Kelley (författare)
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Leong, Darryl P (författare)
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Bangdiwala, Shrikant I (författare)
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Hart, Robert G (författare)
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Yusuf, Salim (författare)
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- Dellborg, Mikael, 1954 (författare)
- Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institute of Medicine, Department of Molecular and Clinical Medicine
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(creator_code:org_t)
- 2018
- 2018
- Engelska.
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Ingår i: Lancet (London, England). - 1474-547X. ; 391:10117, s. 219-229
- Relaterad länk:
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https://gup.ub.gu.se...
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https://doi.org/10.1...
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http://kipublication...
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Abstract
Ämnesord
Stäng
- Patients with peripheral artery disease have an increased risk of cardiovascular morbidity and mortality. Antiplatelet agents are widely used to reduce these complications.This was a multicentre, double-blind, randomised placebo-controlled trial for which patients were recruited at 602 hospitals, clinics, or community practices from 33 countries across six continents. Eligible patients had a history of peripheral artery disease of the lower extremities (previous peripheral bypass surgery or angioplasty, limb or foot amputation, intermittent claudication with objective evidence of peripheral artery disease), of the carotid arteries (previous carotid artery revascularisation or asymptomatic carotid artery stenosis of at least 50%), or coronary artery disease with an ankle-brachial index of less than 0·90. After a 30-day run-in period, patients were randomly assigned (1:1:1) to receive oral rivaroxaban (2·5 mg twice a day) plus aspirin (100 mg once a day), rivaroxaban twice a day (5 mg with aspirin placebo once a day), or to aspirin once a day (100 mg and rivaroxaban placebo twice a day). Randomisation was computer generated. Each treatment group was double dummy, and the patient, investigators, and central study staff were masked to treatment allocation. The primary outcome was cardiovascular death, myocardial infarction or stroke; the primary peripheral artery disease outcome was major adverse limb events including major amputation. This trial is registered with ClinicalTrials.gov, number NCT01776424, and is closed to new participants.Between March 12, 2013, and May 10, 2016, we enrolled 7470 patients with peripheral artery disease from 558 centres. The combination of rivaroxaban plus aspirin compared with aspirin alone reduced the composite endpoint of cardiovascular death, myocardial infarction, or stroke (126 [5%] of 2492 vs 174 [7%] of 2504; hazard ratio [HR] 0·72, 95% CI 0·57-0·90, p=0·0047), and major adverse limb events including major amputation (32 [1%] vs 60 [2%]; HR 0·54 95% CI 0·35-0·82, p=0·0037). Rivaroxaban 5 mg twice a day compared with aspirin alone did not significantly reduce the composite endpoint (149 [6%] of 2474 vs 174 [7%] of 2504; HR 0·86, 95% CI 0·69-1·08, p=0·19), but reduced major adverse limb events including major amputation (40 [2%] vs 60 [2%]; HR 0·67, 95% CI 0·45-1·00, p=0·05). The median duration of treatment was 21 months. The use of the rivaroxaban plus aspirin combination increased major bleeding compared with the aspirin alone group (77 [3%] of 2492 vs 48 [2%] of 2504; HR 1·61, 95% CI 1·12-2·31, p=0·0089), which was mainly gastrointestinal. Similarly, major bleeding occurred in 79 (3%) of 2474 patients with rivaroxaban 5 mg, and in 48 (2%) of 2504 in the aspirin alone group (HR 1·68, 95% CI 1·17-2·40; p=0·0043).Low-dose rivaroxaban taken twice a day plus aspirin once a day reduced major adverse cardiovascular and limb events when compared with aspirin alone. Although major bleeding was increased, fatal or critical organ bleeding was not. This combination therapy represents an important advance in the management of patients with peripheral artery disease. Rivaroxaban alone did not significantly reduce major adverse cardiovascular events compared with asprin alone, but reduced major adverse limb events and increased major bleeding.Bayer AG.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine (hsv//eng)
Nyckelord
- Aged
- Amputation
- statistics & numerical data
- Aspirin
- administration & dosage
- adverse effects
- therapeutic use
- Cardiovascular Diseases
- mortality
- prevention & control
- Carotid Artery Diseases
- complications
- drug therapy
- epidemiology
- Dose-Response Relationship
- Drug
- Double-Blind Method
- Drug Administration Schedule
- Drug Therapy
- Combination
- Factor Xa Inhibitors
- administration & dosage
- adverse effects
- therapeutic use
- Female
- Hemorrhage
- chemically induced
- Humans
- Incidence
- Lower Extremity
- blood supply
- surgery
- Male
- Middle Aged
- Morbidity
- Myocardial Infarction
- epidemiology
- etiology
- prevention & control
- Peripheral Arterial Disease
- complications
- drug therapy
- epidemiology
- Platelet Aggregation Inhibitors
- administration & dosage
- adverse effects
- therapeutic use
- Rivaroxaban
- administration & dosage
- adverse effects
- therapeutic use
- Stroke
- epidemiology
- etiology
- prevention & control
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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Anand, Sonia S
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Bosch, Jackie
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Eikelboom, John ...
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Connolly, Stuart ...
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Diaz, Rafael
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Widimsky, Peter
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visa fler...
-
Aboyans, Victor
-
Alings, Marco
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Kakkar, Ajay K
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Keltai, Katalin
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Maggioni, Aldo P
-
Lewis, Basil S
-
Störk, Stefan
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Zhu, Jun
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Lopez-Jaramillo, ...
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O'Donnell, Marti ...
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Commerford, Patr ...
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Vinereanu, Drago ...
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Pogosova, Nana
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Ryden, Lars
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Fox, Keith A A
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Bhatt, Deepak L
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Misselwitz, Fran ...
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Varigos, John D
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Vanassche, Thoma ...
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Avezum, Alvaro A
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Chen, Edmond
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Branch, Kelley
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Leong, Darryl P
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Bangdiwala, Shri ...
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Hart, Robert G
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Yusuf, Salim
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Dellborg, Mikael ...
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- Om ämnet
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- MEDICIN OCH HÄLSOVETENSKAP
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MEDICIN OCH HÄLS ...
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och Klinisk medicin
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Lancet (London, ...
- Av lärosätet
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Göteborgs universitet
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Karolinska Institutet