Rivaroxaban in Valvular Atrial Fibrillation - a Critical Appraisal of the INVICTUS Trial.

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Drugs and Therapy Pub Date : 2024-10-01 Epub Date: 2023-05-25 DOI:10.1007/s10557-023-07470-z

Andreas Hammer, Alexander Niessner, Patrick Sulzgruber

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引用次数: 0

Abstract

Purpose: The efficacy of factor Xa inhibitors in patients with atrial fibrillation (AF) and rheumatic heart disease (RHD) is unknown.

Methods/results: The objective of this article was to conduct a comprehensive evaluation of the INVICTUS trial, an open-label randomized controlled study that compared vitamin K antagonists (VKA) to rivaroxaban in patients with AF and RHD while also considering the existing evidence from literature in this particular area of research.

Conclusion: The findings of the INVICTUS trial indicated that rivaroxaban was found to be inferior in efficacy to VKA. However, it is important to note that the primary outcome of the trial was driven by sudden death and death caused by mechanical pump failure. As a result, it is necessary to approach the data from this study with caution, and it would be inappropriate to draw parallel conclusions for other causes of valvular AF. Particularly, the perplexing issue of how rivaroxaban could have contributed to both pump failure and sudden cardiac death requires further explanation. Additional data regarding changes in heart failure medication and ventricular function would be essential for proper interpretation.

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利伐沙班治疗瓣膜性心房颤动--INVICTUS 试验批判性评估。

目的：Xa因子抑制剂对心房颤动（AF）和风湿性心脏病（RHD）患者的疗效尚不清楚：INVICTUS试验是一项开放标签随机对照研究，比较了维生素K拮抗剂（VKA）和利伐沙班对房颤和风湿性心脏病患者的疗效，同时还考虑了这一特定研究领域的现有文献证据：INVICTUS试验结果表明，利伐沙班的疗效不如VKA。然而，值得注意的是，试验的主要结果是猝死和机械泵故障导致的死亡。因此，有必要谨慎对待这项研究的数据，不宜对其他原因引起的瓣膜性房颤得出类似结论。特别是，利伐沙班如何同时导致泵衰竭和心脏性猝死这一令人困惑的问题需要进一步解释。有关心衰药物和心室功能变化的更多数据对于正确解释至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cardiovascular Drugs and Therapy 医学-心血管系统

CiteScore

8.30

自引率

0.00%

发文量

110

审稿时长

4.5 months

期刊介绍： Designed to objectively cover the process of bench to bedside development of cardiovascular drug, device and cell therapy, and to bring you the information you need most in a timely and useful format, Cardiovascular Drugs and Therapy takes a fresh and energetic look at advances in this dynamic field. Homing in on the most exciting work being done on new therapeutic agents, Cardiovascular Drugs and Therapy focusses on developments in atherosclerosis, hyperlipidemia, diabetes, ischemic syndromes and arrhythmias. The Journal is an authoritative source of current and relevant information that is indispensable for basic and clinical investigators aiming for novel, breakthrough research as well as for cardiologists seeking to best serve their patients. Providing you with a single, concise reference tool acknowledged to be among the finest in the world, Cardiovascular Drugs and Therapy is listed in Web of Science and PubMed/Medline among other abstracting and indexing services. The regular articles and frequent special topical issues equip you with an up-to-date source defined by the need for accurate information on an ever-evolving field. Cardiovascular Drugs and Therapy is a careful and accurate guide through the maze of new products and therapies which furnishes you with the details on cardiovascular pharmacology that you will refer to time and time again.