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Rivaroxaban fails to take on covert brain infarcts

22 Oct 2020

Use of rivaroxaban, with or without aspirin, falls short of reducing the number of incident covert infarcts compared with aspirin alone in patients with stable coronary and peripheral vascular disease, according to a study.

The current analysis included a subgroup of 1,445 participants with stable vascular disease from the COMPASS trial, which evaluated the effect of rivaroxaban with or without aspirin compared with aspirin monotherapy on stroke, myocardial infarction, and vascular death outcomes. All participants had completed baseline and follow-up magnetic resonance imaging (MRI) with a mean interval of 2.0 years. Whole-brain T1, T2 fluid-attenuated inversion recovery, T2 sequences were centrally interpreted by blinded, trained readers. Cognition and functional status were also assessed.

At baseline, 493 (34.1 percent) participants had infarcts. Incident covert infarcts occurred in 55 (3.8 percent) participants over the follow-up. In the overall trial, rivaroxaban plus aspirin vs aspirin monotherapy reduced the risk of ischaemic stroke by 49 percent (0.7 percent vs 1.4 percent; hazard ratio, 0.51, 95 percent confidence interval [CI], 0.38–0.68).

In the MRI substudy, the combination of rivaroxaban plus aspirin did not significantly differ with aspirin alone in terms of the incidence of covert infarcts (2.7 percent vs 3.5 percent; odds ratio [OR], 0.77, 95 percent CI, 0.37–1.60; p=0.48) and the composite of covert infarcts or ischaemic stroke (2.9 percent vs 5.3 percent; OR, 0.53, 95 percent CI, 0.27–1.03; p=0.061).

Overall, 6.6 percent of participants developed microbleeds and 65.7 percent had an increase in white matter hyperintensities volume, with no effect of treatment for either endpoint. Results for cognitive tests showed no material change.

In light of the findings, the researchers underscored that a sequential hierarchical analysis plan with a combined outcome of covert and clinical infarcts, followed by each component separately, might be optimal.

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Most Read Articles
Roshini Claire Anthony, 13 Nov 2020

Diabetes is a key risk factor for heart failure (HF), which is the leading cause of hospitalization in patients with or without diabetes. SGLT-2* inhibitors (SGLT-2is) have been shown to reduce the risk of hospitalization for HF (HHF) regardless of the presence or absence of diabetes.

5 days ago
Vitamin D deficiency may be a contributing factor to the mortality rate among patients with the novel coronavirus disease (COVID-19), reports a new study.
Pearl Toh, 4 days ago
Inhaled corticosteroid (ICS) should be the mainstay of long-term asthma management — such is the key message of the latest Singapore ACE* Clinical Guidance (ACG) for asthma, released in October 2020.
17 Nov 2020
Invasive fungal infections, particularly those caused by Candida species, are common in hospitalized, immunocompromised, or critically ill patients and are associated with considerable morbidity and mortality.