Abstract
In this randomized controlled trial, Connolly et al (N Engl J Med 2022;387:978, PMID 36036525) sought to assess the safety and efficacy of rivaroxaban vs vitamin K antagonists (VKAs) in patients with rheumatic heart disease (RHD) and atrial fibrillation (AF). Patients with RHD were routinely excluded from the pivotal trials comparing rivaroxaban and other non-VKA oral anticoagulants (NOACs) with the VKA warfarin. The INVICTUS trial (Investigation of Rheumatic AF Treatment Using Vitamin K Antagonists, Rivaroxaban or Aspirin Studies) was conducted in 138 sites in 34 countries in Africa, Latin America, and Asia.
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