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Spyropoulos AC, Lipardi C, Xu J, Lu W, Suh E, Yuan Z, Levitan B, Sugarmann C, De Sanctis Y, Spiro TE, Barnathan ES, Raskob GE. Improved Benefit Risk Profile of Rivaroxaban in a Subpopulation of the MAGELLAN Study. Clin Appl Thromb Hemost 2020; 25:1076029619886022. [PMID: 31746218 PMCID: PMC7019408 DOI: 10.1177/1076029619886022] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Acutely ill medical patients are at risk of venous thromboembolism (VTE) and VTE-related
mortality during hospitalization and posthospital discharge, but widespread adoption of
extended thromboprophylaxis has not occurred. We analyzed a subpopulation within the
MAGELLAN study of extended thromboprophylaxis with rivaroxaban to reevaluate the benefit
risk profile. We identified 5 risk factors for major and fatal bleeding after a clinical
analysis of the MAGELLAN study and analyzed efficacy and safety with these patients
excluded (n = 1551). Risk factors included: active cancer, dual antiplatelet therapy at
baseline, bronchiectasis/pulmonary cavitation, gastroduodenal ulcer, or bleeding within 3
months before randomization. We evaluated efficacy, safety, and benefit risk using
clinically comparable endpoints in the subpopulation. At day 10, rivaroxaban was
noninferior to enoxaparin (relative risk [RR] = 0.82, 95% confidence interval [CI] =
0.58-1.15) and at day 35 rivaroxaban was significantly better than enoxaparin/placebo (RR
= 0.68, 95% CI = 0.53-0.88) in reducing VTE and VTE-related death. Major bleeding was
reduced at day 10 (RR = 2.18, 95% CI = 1.07-4.44 vs 1.19, 95% CI = 0.54-2.65) and at day
35 (2.87, 95% CI = 1.60-5.15 vs 1.48, 95% CI = 0.77-2.84) for MAGELLAN versus this
subpopulation, respectively. The benefit risk profile was favorable in this subpopulation
treated for 35 days, with the number needed to treat ranging from 55 to 481 and number
needed to harm from 455 to 1067 for all pairwise evaluations. Five exclusionary criteria
defined a subpopulation of acutely ill medical patients with a positive benefit risk
profile for in-hospital and extended thromboprophylaxis with rivaroxaban.
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Affiliation(s)
- Alex C Spyropoulos
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,The Feinstein Institute for Medical Research, Manhasset, NY, USA.,Department of Medicine, Anticoagulation and Clinical Thrombosis Services Northwell Health at Lenox Hill Hospital, NY, USA
| | | | - Jianfeng Xu
- Janssen Research & Development, LLC, Raritan, NJ, USA
| | - Wentao Lu
- Janssen Research & Development, LLC, Raritan, NJ, USA
| | - Eunyoung Suh
- Janssen Research & Development, LLC, Raritan, NJ, USA
| | - Zhong Yuan
- Janssen Research & Development, LLC, Raritan, NJ, USA
| | | | | | - Yoriko De Sanctis
- Clinical Development, Pharmaceuticals, Bayer U.S. LLC, Whippany, NJ, USA
| | - Theodore E Spiro
- Clinical Development, Pharmaceuticals, Bayer U.S. LLC, Whippany, NJ, USA
| | | | - Gary E Raskob
- College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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