Clot Chronicles – COMMANDER HF Trial Results

Dr. Sam Goldhaber discusses the COMMANDER HF Trial results that were released at the 2018 European Society of Cardiology Congress in Munich, Germany.

This is Dr. Sam Goldhaber for the Clot Chronicles. We have just returned from the European Society of Cardiology (ESC) meeting in Munich, the largest cardiology meeting in the world. At ESC, we had the presentation of a long awaited trial called COMMANDER HF. COMMANDER HF is a trial of heart failure in patients with a reduced left ventricular ejection fraction. That means that the heart muscle contraction is limited and these patients often are plagued with shortness of breath and fluid build-up.

For a long time, it has been thought that the addition of anticoagulation to the regular heart failure regimen of these patients might reduce heart attack, stroke, and cardiovascular death, it might reduce hospitalization for heart failure episodes. In COMMANDER HF, patients were randomized in a multi-thousand patient study performed around the world, either to very low doses of the blood thinner called rivaroxaban, better known as Xarelto, or to a placebo, in addition to their regular heart failure medication.

It turned out that the primary endpoints of the study, namely reduction in heart failure hospitalizations and reduction in cardiovascular mortality, reduction in heart attack, those were not met. But, there was a very interesting 40 percent reduction in the stroke rate in patients who were randomized to receive rivaroxaban rather than placebo in the COMMANDER HF study.

So, I think that, while the overall approach of giving all heart failure patients with a reduced left ventricular ejection fraction did not prove to be successful in COMMANDER, we got a lot of useful information in the one subgroup which had a spectacular response to rivaroxaban in the group that had a 40% reduction in stroke. This information will be useful for those heart failure patients who are at a particularly high risk of stroke. I think this information will also help us design future heart failure trials that target the use of anticoagulation in a more limited population than just the broad field of heart failure.

This is Dr. Sam Goldhaber, signing off for the Clot Chronicles