Dr Alex C. Spyropoulos on the Significance of the EINSTEIN-CHOICE Rivaroxaban Findings

The results of the EINSTEIN-CHOICE late-breaking trial comparing the effectiveness of rivaroxaban versus aspirin for preventing venous thromboembolism were presented at the American College of Cardiology (ACC) 66th Scientific Session. According to Alex C. Spyropoulos, MD, FACP, FCCP, FRCPC, professor of medicine at the Hofstra Northwell School of Medicine, these findings could shift the paradigm of long-term thrombosis prevention strategies.
Transcript (slightly modified)
In your opinion, what were the most significant findings presented here at the 2017 ACC Scientific Session?
I think at this session of ACC, from a venous thromboembolic point of view, the most significant findings were that of the EINSTEIN-CHOICE trial that was presented earlier today. The findings of the EINSTEIN-CHOICE trial, which compared 2 doses of rivaroxaban, the standard 20 mg dose and then a reduced dose, a 50% dose reduction at 10 mg, both compared to aspirin in a randomized controlled trial, in patients who had undergone 6 to 12 months of anticoagulant therapy. What the trial was looking at was optimal risk-benefit of the 2 rivaroxaban doses versus aspirin.
I think one of the most important findings from that trial was the fact that it established with high-level evidence that rivaroxaban either 20 mg or 10 mg was statistically superior to aspirin with respect to efficacy, and did not incur any increased risk of bleeding. And I think this is very important, because for the first time we have now, as I mentioned, high-level evidence that shows the strategy of extending oral anticoagulant therapy with a direct oral anticoagulant, specifically rivaroxaban, was superior to aspirin from both an efficacy perspective and from a safety perspective, you didn’t incur any increased bleeding risk.

So I think what that does is it really shifts the paradigm of long-term secondary thromboprophylaxis into one of an anticoagulant versus antiplatelet-based strategy, and that’s very significant. This has never been compared before in a randomized controlled trial setting.
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