COMMANDER HF: Rivaroxaban in Patients with Heart Failure, Sinus Rhythm, and Coronary Disease

Title: Patients with Heart Failure, Sinus Rhythm, and Coronary Disease

Design: Multicenter, randomized, double-blind, placebo-controlled trial

Objective: To assess if rivaroxaban could reduce thrombin generation and improve outcomes for patients with worsening CHF and underlying CAD.


Year of publication: 2018

Inclusion Criteria: patients with 3-m history of CHF, LVEF ≤40%, and CAD who had been treated for an initial episode of worsening HF within previous 21 days

Comparison groups: Rivaroxaban 2.5 mg twice daily (n=2,507) vs Placebo (n=2,515)

Primary Outcome:

  • Composite of death, MI, stroke HR 0.94; 95% CI 0.84-1.05; 25% vs 26.2% P=0.27

Secondary Outcome:

  • CV death or HF rehospitalization 37.2% vs 36.9% HR 0.99; 95% CI 0.91-1.09
  • Major bleeding 0.7% vs 0.9% P=0.48

Conclusion: Rivaroxaban was not associated with a significantly lower rate of death, MI, or stroke than placebo among patients with worsening CHF, reduced LVEF, CAD, and no AF

Source: Zannad F, et al. NEJM, 2018; 379:1332-1342