International longitudinal registry of patients with atrial fibrillation and treated with rivaroxaban: RIVaroxaban Evaluation in Real life setting (RIVER)

Background Real-world data on non-vitamin K oral anticoagulants (NOACs) are essential in determining whether evidence from randomised controlled clinical trials translate into meaningful clinical benefits for patients in everyday practice. RIVER (RIVaroxaban Evaluation in Real life setting) is an ongoing international, prospective registry of patients with newly diagnosed non-valvular atrial fibrillation (NVAF) and at least one investigator-determined risk factor for stroke who received rivaroxaban as an initial treatment for the prevention of thromboembolic stroke. The aim of this paper is to describe the design of the RIVER registry and baseline characteristics of patients with newly diagnosed NVAF who received rivaroxaban as an initial treatment. Methods and results Between January 2014 and June 2017, RIVER investigators recruited 5072 patients at 309 centres in 17 countries. The aim was to enroll consecutive patients at sites where rivaroxaban was already routinely prescribed for stroke prevention. Each patient is being followed up prospectively for a minimum of 2-years. The registry will capture data on the rate and nature of all thromboembolic events (stroke / systemic embolism), bleeding complications, all-cause mortality and other major cardiovascular events as they occur. Data quality is assured through a combination of remote electronic monitoring and onsite monitoring (including source data verification in 10% of cases). Patients were mostly enrolled by cardiologists (n = 3776, 74.6%), by internal medicine specialists 14.2% (n = 718) and by primary care/general practice physicians 8.2% (n = 417). The mean (SD) age of the population was 69.5 (11.0) years, 44.3% were women. Mean (SD) CHADS2 score was 1.9 (1.2) and CHA2DS2-VASc scores was 3.2 (1.6). Almost all patients (98.5%) were prescribed with once daily dose of rivaroxaban, most commonly 20 mg (76.5%) and 15 mg (20.0%) as their initial treatment; 17.9% of patients received concomitant antiplatelet therapy. Most patients enrolled in RIVER met the recommended threshold for AC therapy (86.6% for 2012 ESC Guidelines, and 79.8% of patients according to 2016 ESC Guidelines). Conclusions The RIVER prospective registry will expand our knowledge of how rivaroxaban is prescribed in everyday practice and whether evidence from clinical trials can be translated to the broader cross-section of patients in the real world

The effect of duration of amidation of fatty acids with diethanolamine on the surfactant properties

The effects of the duration of direct amidation of fatty acids (FA) with diethanolamine on the composition of the products obtained, their surface‐active properties, and ability to stabilize water‐in‐oil emulsions are studied using the example of tall oil distillate. A certain range of synthesis time that corresponds to the maximum content of diethanolamides in the reaction products, and, as a consequence, the highest surface‐active and emulsifying properties of the products is shown to exist. An increase in the synthesis duration time leads to a deterioration of these properties due to accumulation of the products of secondary reactions. A new mechanism of the amidation process that includes secondary transformations of diethanolamine and its condensation products with FA into 1,4‐bis(2‐hydroxyethyl)piperazine derivatives is proposed. The structures of by‐products are confirmed using high‐performance liquid chromatography‐mass spectrometry (HPLC–MS), infrared (IR), and nuclear magnetic resonance (NMR) spectroscopy methods. It is concluded that the acid value of the product as well as the amount of water released during the synthesis cannot serve as a reliable criterion for completion of the process