Rivaroxaban Improves Acute Coronary Syndrome Outcomes
Apixaban thromboprophylaxis better than enoxaparin; adjuvant vorapaxar not effective/safe
MONDAY, Nov. 14 (HealthDay News) -- Rivaroxaban, but not adjuvant vorapaxar, improves cardiovascular outcomes in patients with acute coronary syndrome (ACS); and long-term venous thromboembolism prophylaxis with apixaban is safe and effective in medically ill patients post-hospital discharge, according to three studies published online Nov. 13 in the New England Journal of Medicine to coincide with presentation at the American Heart Association's Scientific Sessions 2011, held from Nov. 12 to 16 in Orlando, Fla.
Jessica L. Mega, M.D., M.P.H., from the Brigham and Women's Hospital in Boston, and colleagues investigated whether 2.5 or 5 mg doses of rivaroxaban improved cardiovascular outcomes in 15,526 patients with recent ACS. Compared to placebo, rivaroxaban significantly reduced the primary composite end point of death from cardiovascular causes, myocardial infarction, or stroke, with significant improvement for both doses.
Samuel Z. Goldhaber, M.D., from the Brigham and Women's Hospital in Boston, and colleagues investigated whether extended thromboprophylaxis with apixaban was safer and more effective than a shorter treatment with enoxaparin in acutely ill medical patients post hospital discharge. Of the 4,495 patients evaluated, there was no significant difference in the primary efficacy outcome. Major bleeding occurred in significantly more patients in the apixaban group. In a third study, Pierluigi Tricoci, M.D., Ph.D., from Duke Clinical Research Institute in Durham, N.C., and colleagues found that, for patients with ACS, vorapaxar as adjunctive therapy, did not significantly reduce the primary composite end point and significantly increased the risk of major bleeding.
"The addition of vorapaxar to standard therapy did not significantly reduce the primary composite end point," Tricoci's and colleagues write.
Mega's study was supported by Johnson & Johnson and Bayer Healthcare, joint developers of rivaroxaban. Several of the study authors of Goldhaber's study disclosed financial relationships with pharmaceutical companies, including Bristol-Myers Squibb and Pfizer, which funded the study, and jointly developed apixaban. Tricoci's study was funded by Merck, manufacturer of vorapaxar.