Dr Alex C. Spyropoulos on the Significance of the EINSTEIN-CHOICE Rivaroxaban Findings

The results of the EINSTEIN-CHOICE late-breaking trial comparing the effectiveness of rivaroxaban versus aspirin for preventing venous thromboembolism were presented at the American College of Cardiology (ACC) 66^th Scientific Session. According to Alex C. Spyropoulos, MD, FACP, FCCP, FRCPC, professor of medicine at the Hofstra Northwell School of Medicine, these findings could shift the paradigm of long-term thrombosis prevention strategies.

Transcript (slightly modified)

In your opinion, what were the most significant findings presented here at the 2017 ACC Scientific Session?

I think at this session of ACC, from a venous thromboembolic point of view, the most significant findings were that of the EINSTEIN-CHOICE trial that was presented earlier today. The findings of the EINSTEIN-CHOICE trial, which compared 2 doses of rivaroxaban, the standard 20 mg dose and then a reduced dose, a 50% dose reduction at 10 mg, both compared to aspirin in a randomized controlled trial, in patients who had undergone 6 to 12 months of anticoagulant therapy. What the trial was looking at was optimal risk-benefit of the 2 rivaroxaban doses versus aspirin.

I think one of the most important findings from that trial was the fact that it established with high-level evidence that rivaroxaban either 20 mg or 10 mg was statistically superior to aspirin with respect to efficacy, and did not incur any increased risk of bleeding. And I think this is very important, because for the first time we have now, as I mentioned, high-level evidence that shows the strategy of extending oral anticoagulant therapy with a direct oral anticoagulant, specifically rivaroxaban, was superior to aspirin from both an efficacy perspective and from a safety perspective, you didn’t incur any increased bleeding risk.

So I think what that does is it really shifts the paradigm of long-term secondary thromboprophylaxis into one of an anticoagulant versus antiplatelet-based strategy, and that’s very significant. This has never been compared before in a randomized controlled trial setting.