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Recurrent Hospitalization Among Patients With Atrial Fibrillation Undergoing Intracoronary Stenting Treated With 2 Treatment Strategies of Rivaroxaban or a Dose-Adjusted Oral Vitamin K Antagonist Treatment Strategy.

dc.contributor.author Arbetter, D
dc.contributor.author Bode, C
dc.contributor.author Burton, P
dc.contributor.author Chi, G
dc.contributor.author Cohen, M
dc.contributor.author Daaboul, Y
dc.contributor.author Fox, KAA
dc.contributor.author Gibson, Charles Michael
dc.contributor.author Halperin, J
dc.contributor.author Jain, P
dc.contributor.author Korjian, S
dc.contributor.author Lip, GYH
dc.contributor.author Mehran, R
dc.contributor.author Peterson, Eric David
dc.contributor.author Pinto, Duane S
dc.contributor.author van Eickels, M
dc.contributor.author Verheugt, FWA
dc.contributor.author Wildgoose, P
dc.contributor.author Yee, M
dc.coverage.spatial United States
dc.date.accessioned 2017-07-06T13:25:07Z
dc.date.available 2017-07-06T13:25:07Z
dc.date.issued 2017-01-24
dc.identifier https://www.ncbi.nlm.nih.gov/pubmed/27881555
dc.identifier CIRCULATIONAHA.116.025783
dc.identifier.uri https://hdl.handle.net/10161/14990
dc.description.abstract BACKGROUND: Patients with atrial fibrillation who undergo intracoronary stenting traditionally are treated with a vitamin K antagonist (VKA) plus dual antiplatelet therapy (DAPT), yet this treatment leads to high risks of bleeding. We hypothesized that a regimen of rivaroxaban plus a P2Y12 inhibitor monotherapy or rivaroxaban plus DAPT could reduce bleeding and thereby have a favorable impact on all-cause mortality and the need for rehospitalization. METHODS: Stented subjects with nonvalvular atrial fibrillation (n=2124) were randomized 1:1:1 to administration of reduced-dose rivaroxaban 15 mg daily plus a P2Y12 inhibitor for 12 months (group 1); rivaroxaban 2.5 mg twice daily with stratification to a prespecified duration of DAPT of 1, 6, or 12 months (group 2); or the reference arm of dose-adjusted VKA daily with a similar DAPT stratification (group 3). The present post hoc analysis assessed the end point of all-cause mortality or recurrent hospitalization for an adverse event, which was further classified as the result of bleeding, a cardiovascular cause, or another cause blinded to treatment assignment. RESULTS: The risk of all-cause mortality or recurrent hospitalization was 34.9% in group 1 (hazard ratio=0.79; 95% confidence interval, 0.66-0.94; P=0.008 versus group 3; number needed to treat=15), 31.9% in group 2 (hazard ratio=0.75; 95% confidence interval, 0.62-0.90; P=0.002 versus group 3; number needed to treat=10), and 41.9% in group 3 (VKA+DAPT). Both all-cause death plus hospitalization potentially resulting from bleeding (group 1=8.6% [P=0.032 versus group 3], group 2=8.0% [P=0.012 versus group 3], and group 3=12.4%) and all-cause death plus rehospitalization potentially resulting from a cardiovascular cause (group 1=21.4% [P=0.001 versus group 3], group 2=21.7% [P=0.011 versus group 3], and group 3=29.3%) were reduced in the rivaroxaban arms compared with the VKA arm, but other forms of rehospitalization were not. CONCLUSIONS: Among patients with atrial fibrillation undergoing intracoronary stenting, administration of either rivaroxaban 15 mg daily plus P2Y12 inhibitor monotherapy or 2.5 mg rivaroxaban twice daily plus DAPT was associated with a reduced risk of all-cause mortality or recurrent hospitalization for adverse events compared with standard-of-care VKA plus DAPT. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01830543.
dc.language eng
dc.relation.ispartof Circulation
dc.relation.isversionof 10.1161/CIRCULATIONAHA.116.025783
dc.subject atrial fibrillation
dc.subject percutaneous coronary intervention
dc.subject rivaroxaban
dc.subject vitamin K
dc.subject Aged
dc.subject Atrial Fibrillation
dc.subject Factor Xa Inhibitors
dc.subject Female
dc.subject Hospitalization
dc.subject Humans
dc.subject Male
dc.subject Rivaroxaban
dc.subject Stents
dc.subject Treatment Outcome
dc.subject Vitamin K
dc.title Recurrent Hospitalization Among Patients With Atrial Fibrillation Undergoing Intracoronary Stenting Treated With 2 Treatment Strategies of Rivaroxaban or a Dose-Adjusted Oral Vitamin K Antagonist Treatment Strategy.
dc.type Journal article
pubs.author-url https://www.ncbi.nlm.nih.gov/pubmed/27881555
pubs.begin-page 323
pubs.end-page 333
pubs.issue 4
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Duke
pubs.organisational-group Duke Clinical Research Institute
pubs.organisational-group Institutes and Centers
pubs.organisational-group Medicine
pubs.organisational-group Medicine, Cardiology
pubs.organisational-group School of Medicine
pubs.publication-status Published
pubs.volume 135
dc.identifier.eissn 1524-4539


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