Compared with placebo, rivaroxaban when given to higher-risk patients for 45 days following hospital discharge was not associated with significantly lower risk of symptomatic venous thromboembolism (VTE) or death from VTE, based on findings from the MARINER Trial presented Aug. 26 at ESC Congress 2018 and simultaneously published in the New England Journal of Medicine.

The trial randomized 12,024 patients at increased risk for VTE to receive either once-daily rivaroxaban (10 mg) or placebo for 45 days following discharge. The primary endpoint was a composite of symptomatic VTE or death due to VTE. Researchers also looked for major bleeding.

Results found the primary outcome occurred in 50 of the 6,007 patients taking rivaroxaban (0.83 percent) and 66 of the 6,012 patients assigned placebo (1.10 percent). Taken separately, however, while rivaroxaban had no effect on the risk of VTE-related death, there were fewer symptomatic VTE events in those patients taking rivaroxaban compared with those taking placebo (risk difference -0.24 percentage points). Researchers noted a low rate of major bleeding in both groups – 0.28 percent in patients taking rivaroxaban and 0.15 percent in the placebo group.

Given their findings, particularly the lack of effect on VTE-related death, researchers said "the usefulness of extended thromboprophylaxis remains uncertain." They suggest that "future studies should more accurately identify deaths caused by thrombotic mechanisms and focus on the patients who are at highest risk and who may benefit from anticoagulant prophylaxis."

Keywords: ESC18, ESC Congress, Embolism, Patient Discharge, Risk, Hypertension, Pulmonary

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