Abstract 4762: Cessation of Rivaroxaban in Post-ACS Patients is Not Associated With Clinical Evidence of Rebound Hypercoagulability: An ATLAS ACS-TIMI 46 Substudy
Introduction: In vitro and outcome studies suggest that rebound hypercoagulability is present after cessation of some anticoagulants. Rivaroxaban is an oral, direct factor Xa inhibitor that has been shown to reduce major atherothrombotic events in post-ACS patients. Whether rivaroxaban is associated with rebound hypercoagulability in this population remains undefined.
Methods: ATLAS ACS-TIMI 46 randomized post-ACS patients to placebo or rivaroxaban (5–20 mg) for 6 mos, with a 30 day follow-up visit. This analysis included 3367 subjects with ≥1 day follow-up after last study drug administration. Cox regression was used to assess the risk of events (primary: death, MI, stroke, or severe recurrent ischemia requiring revascularization; secondary: death, MI, or stroke) within 10 days of cessation of study drug.
Results: Among subjects who completed the treatment period (N=2808), cessation of rivaroxaban and placebo was associated with a similar rate of the primary (HR 1.03, 95% CI 0.19–5.64) and secondary (HR 0.77, 95% CI 0.13–4.64) endpoints. Moreover, among subjects who discontinued study drug early (N±559), there were no significant differences in the risk of events after cessation of rivaroxaban and placebo (Figure⇓). Overall (N=3367), the risk of death or cardiovascular events after discontinuation of study drug was similar with rivaroxaban and placebo (primary: HR 1.28, 95% CI 0.59–2.77; secondary: HR 1.11, 95% CI 0.51–2.44).
Conclusion: In post-ACS patients, discontinuation of rivaroxaban as compared with placebo is not associated with an increase in death or cardiovascular events, and thus there does not appear to be clinical evidence of rebound hypercoagulability.