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Rivaroxaban in Patients With Atrial Fibrillation and a Bioprosthetic Mitral Valve

Saturday, November 28, 2020

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Source Name: The New England Journal Of Medicine


Helio P. Guimarães, Renato D. Lopes, Pedro G.M. de Barros e Silva, Idelzuita L. Liporace, Roney O. Sampaio, Flávio Tarasoutchi, Conrado R. Hoffmann-Filho, Rodrigo de Lemos Soares Patriota, Tiago L.L. Diana Lamprea, Dalton B. ., Fernando A. Atik, Fabio S. Silveira, ., Fabio R. Farias, Diogo O. Barreto, Adail P. Almeida, Alexandre C. Zilli, João D. de Souza Neto, Margaret A. Cavalcante, Fernando A.M.S. Figueira, Flávia C.S. Kojima, Lucas Damiani, Renato H.N. Santos, Nanci Valeis, Viviane B. Campos, Jose F.K. Saraiva, Francisco H. Fonseca, Ibraim M. Pinto, Carlos C. Magalhães, Joao F.M. Ferreira, John H. Alexander, Ricardo Pavanello, Alexandre B. Cavalcanti, Otavio Berwanger, for the RIVER Trial Investigators

A large RCT with results somewhat supportive of considering a NOAC in the place of warfarin for post operative surgical patients. The study will be weighed against healthcare economical aspects. One question will arise:  Why,  if there was a subgroup ( the cohort had an average age below 60 years) eceiving lifelong warfarin or equivalent anticoagulation prior to surgery, they did not have a mechanical prosthesis?  It is of course possible that local financial constrains impede access to such devices, and bioprostheses were more affordable.  

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