A1 Vertaisarvioitu alkuperäisartikkeli tieteellisessä lehdessä
Rivaroxaban versus aspirin for secondary prevention of ischaemic stroke in patients with cancer: a subgroup analysis of the NAVIGATE ESUS randomized trial
Tekijät: N. Martinez‐Majander, G. Ntaios, Y. Y. Liu , P. Ylikotila, H. Joensuu, J. Saarinen, K. S. Perera, J. Marti‐Fabregas, A. Chamorro, S. Rudilosso, L. Prats‐Sanchez , S. D. Berkowitz, H. Mundl, E. Themeles, M. Tiainen, A. Demchuk, S. E. Kasner, R. G Hart, T. Tatlisumak; on behalf of the NAVIGATE ESUS investigators
Kustantaja: WILEY
Julkaisuvuosi: 2020
Journal: European Journal of Neurology
Tietokannassa oleva lehden nimi: EUROPEAN JOURNAL OF NEUROLOGY
Lehden akronyymi: EUR J NEUROL
Vuosikerta: 27
Numero: 5
Aloitussivu: 841
Lopetussivu: 848
Sivujen määrä: 8
ISSN: 1351-5101
eISSN: 1468-1331
DOI: https://doi.org/10.1111/ene.14172
Rinnakkaistallenteen osoite: https://helda.helsinki.fi/bitstream/10138/326415/1/Martinez_Majander_et_al_2020_European_Journal_of_Neurology.pdf
Background and purpose Cancer is a frequent finding in ischaemic stroke patients. The frequency of cancer amongst participants in the NAVIGATE ESUS randomized trial and the distribution of outcome events during treatment with aspirin and rivaroxaban were investigated.Methods Trial participation required a recent embolic stroke of undetermined source. Patients' history of cancer was recorded at the time of study entry. During a mean follow-up of 11 months, the effects of aspirin and rivaroxaban treatment on recurrent ischaemic stroke, major bleeding and all-cause mortality were compared between patients with cancer and patients without cancer.Results Amongst 7213 randomized patients, 543 (7.5%) had cancer. Of all patients, 3609 were randomized to rivaroxaban [254 (7.0%) with cancer] and 3604 patients to aspirin [289 (8.0%) with cancer]. The annual rate of recurrent ischaemic stroke was 4.5% in non-cancer patients in the rivaroxaban arm and 4.6% in the aspirin arm [hazard ratio (HR) 0.98, 95% confidence interval (CI) 0.78-1.24]. In cancer patients, the rate of recurrent ischaemic stroke was 7.7% in the rivaroxaban arm and 5.4% in the aspirin arm (HR 1.43, 95% CI 0.71-2.87). Amongst cancer patients, the annual rate of major bleeds was non-significantly higher for rivaroxaban than aspirin (2.9% vs. 1.1%; HR 2.57, 95% CI 0.67-9.96; P for interaction 0.95). All-cause mortality was similar in both groups.Conclusions Our exploratory analyses show that patients with embolic stroke of undetermined source and a history of cancer had similar rates of recurrent ischaemic strokes and all-cause mortality during aspirin and rivaroxaban treatments and that aspirin appeared safer than rivaroxaban in cancer patients regarding major bleeds. (NCT02313909).
