Extending thromboembolic prophylaxis with rivaroxaban in patients hospitalized for heart conditions reduce fatal and thromboembolic events by 28% without major bleeding payback.  

Patients hospitalized for heart conditions are at risk of thromboembolic events, and this is why inhospital prophylaxis (in general with low molecular weight heparin) is within the standard treatment.

It was not clear whether extending primary prophylaxis would prevent thromboembolic events or, on the contrary, would be an unjustified bleeding risk.

The MARINER study (A Study of Rivaroxaban on the Venous Thromboembolic Risk in Post-Hospital Discharge Patients) included patients requiring hospitalization for cardiac cause also presenting thrombosis risk factors.

The double-blind study randomized 4909 patients to 10 mg rivaroxaban a day for 45 days after discharge, and 4913 patients to placebo.

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Final combined efficacy end point (symptomatic venous thrombosis, myocardial infarction, ischemic stroke, and cardiovascular dead) occurred in 1.28% of patients receiving rivaroxaban vs 1.77% of patients receiving placebo (HR 0.72; CI 95%: 0.52 to 1.00; p=0.049). The difference in major bleeding was non-significant (rivaroxaban group 0.27% vs 0.18%; p=0.398).

Conclusion

Extending prophylaxis duration with rivaroxaban for 45 days after discharge reduced fatal and thromboembolic events rate by 28% with no increase in bleeding.

Original Title: Post-Discharge Prophylaxis With Rivaroxaban Reduces Fatal and Major Thromboembolic Events in Medically Ill Patients.

Reference: Alex C. Spyropoulos et al. J Am Coll Cardiol 2020;75:3140–7. https://doi.org/10.1016/j.jacc.2020.04.071.

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