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Safety and efficacy of rivaroxaban for the secondary prevention following acute coronary syndromes among biomarker-positive patients: Insights from the ATLAS ACS 2-TIMI 51 trial.
- Source :
-
European heart journal. Acute cardiovascular care [Eur Heart J Acute Cardiovasc Care] 2019 Mar; Vol. 8 (2), pp. 186-193. Date of Electronic Publication: 2017 Dec 18. - Publication Year :
- 2019
-
Abstract
- Background:: Despite dual antiplatelet therapy, persistent thrombin generation and thrombin-mediated platelet activation account in part for the residual risk of atherothrombotic disease among patients with prior acute coronary syndrome (ACS). Inhibition of thrombin generation among high-risk ACS patients (biomarker-positive ACS) with the factor Xa inhibitor rivaroxaban may limit ongoing thrombus formation and myocardial necrosis and thereby improve clinical outcomes.<br />Objectives and Methods:: ATLAS ACS 2-TIMI 51 was a double-blind, placebo-controlled clinical trial that randomized ACS patients to either rivaroxaban 2.5 mg b.i.d., rivaroxaban 5 mg b.i.d., or placebo plus standard-of-care antiplatelet therapy for a mean of 13.1 months and up to 31 months ( N=15,526). This post-hoc analysis evaluates the safety and efficacy of rivaroxaban among biomarker-positive ACS patients with and without a history of prior stroke of transient ischemic attack in the ATLAS ACS 2-TIMI 51 trial.<br />Results:: A total of 12,626 biomarker-positive ACS patients were included in this analysis. Among biomarker-positive patients without a prior history of stroke or transient ischemic attack, rivaroxaban 2.5 b.i.d. was associated with a reduction in the primary efficacy endpoint (composite of cardiovascular death, myocardial infarction, or stroke) as compared with placebo (hazard ratio=0.80, 95% confidence interval (0.68-0.94), p=0.007) at the expense of an increase in non-coronary-artery-bypass-graft-related Thrombolysis in Myocardial Infarction major bleeding (1.9% vs. 0.7%, p<0.0001), but not a significant increase in either intracranial hemorrhage (0.4% vs. 0.2%, p=0.11) or fatal bleeding (0.1% vs. 0.3%, p=0.16).<br />Conclusion:: Rivaroxaban 2.5 mg b.i.d. was associated with a significant reduction in the composite of cardiovascular death, myocardial infarction, or stroke with no increase in fatal bleeding. Biomarker-positive patients with no prior history of stroke or transient ischemic attack may be a optimal target population to receive "dual pathway" therapy with rivaroxaban plus dual antiplatelet therapy for secondary prevention following ACS.
- Subjects :
- Administration, Oral
Biomarkers blood
Dose-Response Relationship, Drug
Double-Blind Method
Drug Therapy, Combination
Factor Xa Inhibitors administration & dosage
Follow-Up Studies
Humans
Platelet Aggregation Inhibitors administration & dosage
Thrombosis blood
Thrombosis etiology
Time Factors
Treatment Outcome
Acute Coronary Syndrome complications
Rivaroxaban administration & dosage
Secondary Prevention methods
Thrombolytic Therapy methods
Thrombosis prevention & control
Troponin blood
Subjects
Details
- Language :
- English
- ISSN :
- 2048-8734
- Volume :
- 8
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- European heart journal. Acute cardiovascular care
- Publication Type :
- Academic Journal
- Accession number :
- 29249166
- Full Text :
- https://doi.org/10.1177/2048872617745003