Evidence map›Paper›PMID 40163217›Full record

Trial reportDrugs & aging2025

Benefit-Risk Assessment of Rivaroxaban in Older Patients With Nonvalvular Atrial Fibrillation or Venous Thromboembolism.

Paul P Dobesh, Albert A Volkl, Ákos Ferenc Pap, C V Damaraju, Bennett Levitan, Zhong Yuan, Alpesh N Amin

5 registry-linked trialsAbstract readRandomized Controlled Trial
In one paragraph

Trial report in Drugs & aging, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 5 registered trials, which are not on this map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00403767 phase3completednot on this map

A Prospective, Randomized, Double-Blind, Parallel-Group, Multicenter, Non-inferiority Study Comparing the Efficacy and Safety of Rivaroxaban (BAY 59-7939) With Warfarin for the Prevention of Stroke and Non-Central Nervous System Systemic Embolism in Subjects With Non-Valvular Atrial Fibrillation

TypeinterventionalSponsorJohnson & Johnson Pharmaceutical Research & Development, L.L.C.Ran2006 to 2010Enrolled14,269ConditionsAtrial Fibrillation, Stroke, EmbolismArmsRivaroxaban, Warfarin, Matching placebo for Rivaroxaban arm (Warfarin placebo), Matching placebo for Warfarin arm (Rivaroxaban placebo)
NCT00439725 phase3completednot on this map

Once-daily Oral Direct Factor Xa Inhibitor Rivaroxaban in the Long-term Prevention of Recurrent Symptomatic Venous Thromboembolism in Patients With Symptomatic Deep-vein Thrombosis or Pulmonary Embolism. The Einstein-Extension Study

TypeinterventionalSponsorBayerRan2007 to 2009Enrolled1,197ConditionsVenous ThromboembolismArmsRivaroxaban (Xarelto, BAY59-7939), Placebo
NCT00439777 phase3completednot on this map

Oral Direct Factor Xa Inhibitor Rivaroxaban in Patients With Acute Symptomatic Deep-Vein Thrombosis or Pulmonary Embolism

TypeinterventionalSponsorBayerRan2007 to 2011Enrolled4,833ConditionsPulmonary EmbolismArmsRivaroxaban (Xarelto, BAY59-7939), Enoxaparin overlapping with and followed by VKA
NCT00440193 phase3completednot on this map

Oral Direct Factor Xa Inhibitor Rivaroxaban in Patients With Acute Symptomatic Deep-Vein Thrombosis or Pulmonary Embolism

TypeinterventionalSponsorBayerRan2007 to 2010Enrolled3,449ConditionsVenous ThrombosisArmsRivaroxaban (Xarelto, BAY59-7939), Enoxaparin followed by VKA
NCT02064439 phase3completednot on this map

Reduced-dosed Rivaroxaban and Standard-dosed Rivaroxaban Versus ASA in the Long-term Prevention of Recurrent Symptomatic Venous Thromboembolism in Patients With Symptomatic Deep-vein Thrombosis and/or Pulmonary Embolism

TypeinterventionalSponsorBayerRan2014 to 2016Enrolled3,365ConditionsPulmonary Embolism, Thromboembolism, Thrombosis, Venous ThrombosisArmsBAY 59-7939, ASA
3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Paul P DobeshUniversity of Nebraska Medical Center College of Pharmacy, 986120 Nebraska Medical Center, Omaha, NE, 68198-6120, USA. pdobesh@unmc.edu.ORCID 0000-0002-2668-7168
Albert A VolklJohnson & Johnson, Titusville, NJ, USA.
Ákos Ferenc PapBayer AG, Wuppertal, Germany.
C V DamarajuJohnson & Johnson, Titusville, NJ, USA.
Bennett LevitanJohnson & Johnson, Titusville, NJ, USA.
Zhong YuanJohnson & Johnson, Horsham, PA, USA.
Alpesh N AminIrvine Department of Medicine, Division of Hospital Medicine and Palliative Medicine, School of Medicine, University of California, Irvine, CA, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundBoth bleeding and adverse ischemic events increase with age, compounding the benefit-risk balance of anticoagulants in older patients. We present analyses using benefit-risk methods to better understand the age-dependence of the benefit-risk profile of rivaroxaban in patients with nonvalvular atrial fibrillation (NVAF) or venous thromboembolism (VTE).

methodsRandomized controlled trial data from the ROCKET-AF (NVAF) and EINSTEIN DVT, EINSTEIN PE, EINSTEIN-Extension, and EINSTEIN CHOICE in (VTE) were used. For ROCKET-AF, benefits and risks were assessed with incidence rates for key thrombotic and bleeding endpoints and a net clinical benefit (NCB) measure. Cumulative incidences (estimated by the Kaplan-Meier method) were estimated at day 185 for EINSTEIN and EINSTEIN Extension and 1 year for EINSTEIN CHOICE. Incidence differences were calculated for the overall population and age subgroups of < 65, 65-75, and > 75 years.

resultsIn ROCKET-AF, rate differences in the composite NCB outcome (vascular death, stroke, myocardial infarction, fatal bleeding, critical organ bleeding, and non-CNS systemic embolism) favored rivaroxaban overall and by age < 65, 65-75, and > 75 years (-84, -25, -61, and -150 cases per 10,000 patient-years, respectively). In the pooled EINSTEIN DVT and EINSTEIN PE studies, cumulative incidence differences for the composite NCB outcome (recurrent VTE and major bleeding) were -103, 3, -105, and -544 per 10,000 patients, respectively. For extended VTE treatment with rivaroxaban versus placebo in EINSTEIN-Extension, NCB results were -536, -492, -556, and -601 per 10,000 patients, respectively. In the EINSTEIN CHOICE analysis, NCB favored rivaroxaban 20 mg versus aspirin (-284, -255, -339, and -338, respectively) and rivaroxaban 10 mg versus aspirin (-339, -328, -485, and -80, respectively).

conclusionsThis analysis demonstrated a positive benefit-risk profile with rivaroxaban versus trial comparators in older patients with NVAF or VTE, with benefit-risk increasingly favoring rivaroxaban with increasing age. CLINICAL

trial registrationhttp://ClinicalTrials.gov , identifiers: NCT00403767 (ROCKET-AF), NCT00440193 (EINSTEIN DVT), NCT00439777 (EINSTEIN PE), NCT00439725 (EINSTEIN Extension), and NCT02064439 (EINSTEIN CHOICE).

Indexed as

AnticoagulantsAtrial FibrillationFactor Xa InhibitorsRivaroxabanVenous ThromboembolismAgedAged, 80 and overAge FactorsFemaleHemorrhageHumansMaleMiddle AgedRisk AssessmentAnticoagulantsFactor Xa InhibitorsRivaroxaban

Identifiers

PMID40163217
PMCPMC12053352

What Socratic holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.