Atrial fibrillation (AF) is a common arrhythmia seen in patients with rheumatic heart disease (RHD). RHD is a condition that results from damage to the heart valves caused by rheumatic fever, an inflammatory condition that can occur after a streptococcal infection. In patients with RHD, AF is often associated with an increased risk of stroke and systemic embolism. Anticoagulation is therefore an important management strategy in these patients.
A study randomly assigned patients with rheumatic heart disease-associated atrial fibrillation to receive either dose-adjusted vitamin K antagonist or standard doses of rivaroxaban. The primary efficacy outcome was a composite of stroke, systemic embolism, myocardial infarction, or death from vascular (cardiac or noncardiac) or unknown causes. Results showed that patients treated with vitamin K antagonist therapy had a lower incidence of cardiovascular events or death compared to those treated with rivaroxaban therapy, without an increased risk of bleeding.
In patients who have atrial fibrillation associated with rheumatic heart disease, the vitamin K antagonist therapy as warfarin led to a lower rate of cardiovascular events or deaths compared to rivaroxaban therapy, a new study has demonstrated in NEJM published in August 2022. There was no significant difference in the rate of major bleeding reported.
