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Rivaroxaban offers no benefit after AF ablation

After successful AF ablation, rivaroxaban did not lower stroke/systemic embolism versus aspirin and increased nonmajor bleeding. International, open-label randomized, blinded-outcome-assessment trial; Level 1b (2011 OCEBM).

Background

Whether anticoagulation can be safely stopped after successful atrial fibrillation (AF) ablation is uncertain.

Patients

1284 adults ≥1 year post-successful AF ablation; mean age 66; 29% women; mean CHA2DS2-VASc 2.2 (32% ≥3).

Intervention

Rivaroxaban 15 mg once daily.

Control

Aspirin 70-120 mg once daily.

Results

Outcome	Rivaroxaban	Aspirin	NNT/NNH
Primary efficacy	5/641 (0.8%)	9/643 (1.4%)	NNT 167
Clinically relevant nonmajor bleeding	35/641 (5.5%)	10/643 (1.6%)	NNH 26

Limitations

Low event rates; trial underpowered for modest effects.
Open-label; early enrollment stop for futility.

Top 20 Journals Rankings - November

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442 abstracts scored across 7 criteria. Click any article to expand criterion scores.

1. 8.5 Menopausal Hormone Therapy and Cardiovascular Diseases in Women With Vasomotor Symptoms

View 7 Criterion Scores

Primary-Care Relevance9.0

Management of menopausal vasomotor symptoms and HT counseling are common in primary care.

Patient-Oriented Outcomes10.0

Assesses major adverse cardiovascular events (MI, stroke, PAD, CVD death) and symptom relief.

Impact/Effect Size8.0

Shows substantial VMS relief and clinically meaningful increased ASCVD risk in women ≥70.

Study Design Quality8.0

Secondary analysis of two large RCTs (WHI) with randomized exposure.

Practicality8.0

Findings readily implementable as age-stratified counseling on HT.

Sample Size & Precision8.0

Very large cohort with adequate power; harms in ≥70 are precise enough to exclude null.

Novelty & Practice-Changing5.0

Largely reinforces existing guidelines rather than overturns practice.

2. 8.4 Nirsevimab Prophylaxis and Respiratory Syncytial Virus Hospitalizations Among Infants

View 7 Criterion Scores

Primary-Care Relevance9.0

RSV prevention in infants is common in family medicine/pediatrics and directly influences routine newborn care.

Patient-Oriented Outcomes9.0

Primary outcome is RSV hospitalization with severity measures (HFNC, ICU)—all patient-important.

Impact/Effect Size9.0

Large relative risk reductions (HR ~0.32) with meaningful clinical implications.

Sample Size & Precision9.0

Large cohort (n≈13,600) with adequate events and narrow CIs.

Practicality8.0

Single-dose seasonal prophylaxis is implementable in outpatient settings.

Study Design Quality7.0

Retrospective multicenter cohort; nonrandomized design limits causal certainty.

Novelty & Practice-Changing6.0

Adds real-world data supporting guideline implementation; incremental rather than paradigm-changing.

3. 8.2 Benefits and harms of ADHD interventions: umbrella review

4. 8.2 Reduction of Antihypertensive Treatment in Nursing Home Residents

5. 8.2 Safety Planning vs Standard Care for Suicide Prevention

6. 8.1 Beta-Blockers after MI in Patients without Heart Failure

7. 8.1 Monthly ibrexafungerp for recurrent vulvovaginal candidiasis

8. 8.1 High-dose influenza vaccine in older adults

9. 8.1 Lifestyle, genetics and incident diverticulitis

10. 8.1 Modified mRNA Influenza Vaccine efficacy & safety

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