Dr Alex C. Spyropoulos: What EINSTEIN-CHOICE Rivaroxaban Findings Mean for Clinical Practice

The EINSTEIN-CHOICE findings presented at the American College of Cardiology 66^th Session demonstrated some promising outcomes, showing that rivaroxaban is a viable option for long-term prevention of venous thromboembolism (VTE) in some patients, said Alex C. Spyropoulos, MD, FACP, FCCP, FRCPC, professor of medicine at the Hofstra Northwell School of Medicine.

Transcript (slightly modified)

What will the EINSTEIN-CHOICE findings mean for clinical practice?

I think these are significant, because what we know now is that there is a significant proportion of patients, particularly with unprovoked VTE, that go on to develop recurrent events within 2, 3, 5 years, et cetera. So having a strategy that incurs a greater efficacy than what was once thought in terms of either placebo, which the EINSTEIN extension trial showed us a while back, but now importantly with aspirin, as that has been heralded as an option.

Again, an important about 60 to 70% risk reduction compared to active therapy aspirin with no added risk of bleeding tells us that now patients with likely unprovoked disease, specifically, could probably benefit from long-term secondary thromboprophylaxis.

Now, there’s some caveats. There was some equipoise as to patients who the investigator thought already should be on extended secondary thromboprophylaxis were likely not good candidates for this trial. Also, patients with provoked disease, unless there are what we call constant risk factors, such as malignancy, et cetera, usually those patients will go on an anticoagulant strategy for 3 to 6 months.

But nevertheless, I think in most of the categories of unprovoked VTE, and some categories of provoked VTE, especially with what we call constant VTE risk factors, they would benefit from a long-term secondary prophylactic strategy.

So indeed, what we’re seeing with unprovoked VTE is very similar to the realm of cardiovascular disease. Once you have an event, you likely would benefit from long-term secondary thromboprophylaxis, provided that the bleeding risk is either low to moderate.