Rivaroxaban in Mechanical Valves: RMV Study (RMV)
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|ClinicalTrials.gov Identifier: NCT02894307|
Expanded Access Status : No longer available
First Posted : September 9, 2016
Last Update Posted : March 13, 2018
|Condition or disease||Intervention/treatment|
|Prosthesis; Cardiac, Heart, Functional Disturbance as Result||Drug: Rivaroxaban|
Anticoagulant treatment reduces the incidence of death and cardioembolic events in patients with atrial ﬁbrillation or prosthetic heart valve and the incidence of death and recurrences in patients with VTE.
Warfarin and similar vitamin K antagonists (VKA) have been the standard therapy for patients with a metallic valve, or bioprosthesis with atrial fibrillation (AF). Warfarin works by binding to vitamin K epoxide reductase to inhibit vitamin K-dependent coagulation factors II, VII, IX, and X. For all its extensive use, warfarin has many clinical shortcomings, including variable pharmacokinetic and pharmacodynamics properties, a narrow therapeutic index range, and numerous interactions with certain foods and drugs. All of these factors contribute to the need for frequent coagulation laboratory monitoring and dosage adjustments.
Even with the appropriate use of therapy, the incidence of thromboembolic events is still substantial: 1-4% per year. Furthermore, bleeding risk is significant, ranging from 2% to 9% per year. The VKA's narrow therapeutic index and they have a complex pharmacology, e.g. long pharmacologic inertia and the common interaction with other drugs. These features make the management of these drugs a challenge for physicians and their patients.
The Dabigatran versus Warfarin in Patients with Mechanical Heart Valves (RE-ALIGN) trial comparing dabigatran etexilate to warfarin was the only randomized controlled study in patient with mechanical valve prosthesis, but it was terminated prematurely because of an excess of thromboembolic and bleeding events among patients in the dabigatran group. Most thromboembolic events among patients in the dabigatran group occurred in population A (patients who had started a study drug within 7 days after valve surgery), with fewer occurring in population B (patients who had undergone valve implantation more than 3 months before randomization). Besides, stroke, death and major bleeding occurred only in population A. In this study, rivaroxaban will be used in patients with mechanical valves and unstable INR in a before and after designed.
|Study Type :||Expanded Access|
|Expanded Access Type :||Individual Patients|
|Official Title:||Evaluation of Thromboembolic Events in Patients With Bileaflet Mechanical Valves in Mitral Position Before and After Rivaroxaban Use: RMV Study|
- Drug: Rivaroxaban
In patients with mechanical valves and unstable INROther Name: Xarelto 15 mg