Rivaroxaban Noninferior to Warfarin for Atrial Fibrillation in Patients with Bioprosthetic Mitral Valves

The RIVER trial supports use of rivaroxaban as a safe, effective alternative to warfarin in this patient population.

Optimal anticoagulation strategies remain unclear for patients with atrial fibrillation and bioprosthetic valves. The RIVER trial (NCT02303795) assessed the efficacy and safety of standard-dose rivaroxaban compared with dose-adjusted warfarin (to maintain an international normalized ratio [INR] of 2 to 3) in this population.

In this industry-funded trial, 1005 patients underwent randomization across 49 sites in Brazil. The primary outcome was a composite of death, major cardiovascular events (stroke, transient ischemic attacks, systemic embolism, valve thrombosis, or hospitalization for heart failure), or major bleeding at 12 months. The mean CHA₂DS₂-VASc score was 2.6, and the interval between mitral valve surgery and randomization was less…

Reviewing Author

Fatima Rodriguez, MD, MPH, FACC, FAHA

Disclosures

Consultant/Advisory BoardNovoNordisk; HealthPals; Novartis; Amgen

EquityHealthPals; Carta

Grant/Research SupportNational Institutes of Health/National Heart, Lung, and Blood Institute; American Heart Association–Robert Wood Johnson Foundation

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