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Rivaroxaban or Aspirin for Extended Treatment of Venous Thromboembolism | NEJM
Efficacy
Table 2.
Prespecified Efficacy Outcomes.
A primary efficacy outcome event occurred in 17 of 1107 patients (1.5%) who were receiving 20 mg of rivaroxaban and in 13 of 1127 patients (1.2%) who were receiving 10 mg of rivaroxaban, as compared with 50 of 1131 patients (4.4%) who were receiving aspirin. Fatal venous thromboembolism occurred in 2 patients (0.2%) who were receiving 20 mg of rivaroxaban, in no patients who were receiving 10 mg of rivaroxaban, and in 2 patients (0.2%) who were receiving aspirin (Table 2). Both rivaroxaban doses were superior to aspirin with respect to the primary efficacy outcome (hazard ratio for 20 mg of rivaroxaban vs. aspirin, 0.34; 95% confidence interval [CI], 0.20 to 0.59; hazard ratio for 10 mg of rivaroxaban vs. aspirin, 0.26; 95% CI, 0.14 to 0.47; P<0.001 for both comparisons). The hazard ratio for the comparison between the 20-mg and 10-mg rivaroxaban regimens was 1.34 (95% CI, 0.65 to 2.75; P=0.42). Similar results were found for the other efficacy outcomes (Table 2, and Table S4 in the Supplementary Appendix).
Table 3.
Rates of Recurrent Venous Thromboembolism and Major Bleeding, According to Risk Profile and Duration of Anticoagulation before Randomization.
Figure 2.
Kaplan–Meier Rates of Recurrent Fatal or Nonfatal Venous Thromboembolism and Major Bleeding.
With aspirin, the rate of recurrent venous thromboembolism was 3.6% among the patients in whom the index event was provoked (i.e., associated with a known event, such as surgery or hospital admission) and 5.6% among those in whom the index event was unprovoked (i.e., idiopathic) (Table 3). Rates of recurrence in patients whose index events were provoked or unprovoked were lower in both the 20-mg rivaroxaban group (1.4% and 1.8%, respectively) and the 10-mg rivaroxaban group (0.9% and 1.5%, respectively) than in the aspirin group.
Aspirin alone a good clot buster after knee surgery -- ScienceDaily
Over three months, just 1.16 percent of aspirin patients developed a serious blood clot. That was true for 1.42 percent of anticoagulant patients, according to the Michigan study. This was not statistically different.
So, neither drug appeared better than the other -- but aspirin has some obvious advantages.
"Aspirin is easy to take and much less expensive," Hallstrom says. "Patients can get it over the counter for pennies, while the other anticoagulants require monitoring, injections, frequent dose adjustments and are extremely expensive."
The reported cost for a 30-day supply of rivaroxaban is approximately $379 to $450; heparin is estimated at $450 to $890. Although warfarin costs a few dollars for a 30-day supply, its cost approaches that of the other anticoagulants when doctor visits for monitoring are factored in, Hallstrom says.