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Rivaroxaban, warfarin yield similar outcomes after peripheral artery procedures
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The use of rivaroxaban or warfarin after endovascular or open peripheral artery procedures confers similar safety and efficacy outcomes, according to new findings.
Researchers conducted a retrospective study of 94 patients who were prescribed rivaroxaban (Xarelto, Janssen Pharmaceuticals; n = 44; mean age, 61 years) or warfarin (n = 50; mean age, 64 years) for stroke prevention or venous thromboembolism treatment after a peripheral artery procedure at a single center between December 2012 and August 2014.
Outcomes of interest included bleeding and reintervention. Demographics, bleeding risk factors and intervention types were similar in both groups.
Major bleeding complications did not significantly differ between the groups (rivaroxaban, 6.8%; warfarin, 16%), nor did transfusion requirements for packed red blood cells (rivaroxaban, 7 U; warfarin, 8 U), Anjan Talukdar, MD, from the division of vascular surgery at the University of Indiana, Indianapolis, and colleagues wrote.
However, in a subgroup analysis of patients by age, in those aged 65 years and younger, there were fewer bleeding complications in the rivaroxaban group (0% vs. 20% for warfarin; P = .02), especially in younger patients who underwent open surgery (rivaroxaban, 0%; warfarin, 26.3%; P = .016), according to the researchers.
Reintervention was required in 20 patients from the rivaroxaban group and 16 patients from the warfarin group (P = .207), but in a subgroup analysis by procedure type, among those who underwent open procedures, the reintervention rate was higher in the rivaroxaban group (44.4% vs. 22.9%; P = .047), Talukdar and colleagues wrote.
In addition, among patients aged 65 years and older, there was a trend toward higher risk for reintervention in the rivaroxaban group (50% vs. 18.8%; P = .077).
“Warfarin may continue to be an appropriate first choice of anticoagulation for older patients after an open surgical procedure,” Talukdar and colleagues wrote. “In patients aged 65 years, rivaroxaban may be used as the first-line agent if these patients are in the high-risk category for bleeding; however, there is an increased incidence of reintervention.” – by Erik Swain
Disclosures: The authors report no relevant financial disclosures.
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