A controlled trial of rivaroxaban after transcatheter aortic-valve replacement

Background: whether the direct factor Xa inhibitor rivaroxaban can prevent thromboembolic events after transcatheter aortic-valve replacement (TAVR) is unclear. Methods: we randomly assigned 1644 patients without an established indication for oral anticoagulation after successful TAVR to receive rivaroxaban at a dose of 10 mg daily (with aspirin at a dose of 75 to 100 mg daily for the first 3 months) (rivaroxaban group) or aspirin at a dose of 75 to 100 mg daily (with clopidogrel at a dose of 75 mg daily for the first 3 months) (antiplatelet group). The primary efficacy outcome was the composite of death or thromboembolic events. The primary safety outcome was major, disabling, or life-threatening bleeding. The trial was terminated prematurely by the data and safety monitoring board because of safety concerns. Results: after a median of 17 months, death or a first thromboembolic event (intention-to-treat analysis) had occurred in 105 patients in the rivaroxaban group and in 78 patients in the antiplatelet group (incidence rates, 9.8 and 7.2 per 100 person-years, respectively; hazard ratio with rivaroxaban, 1.35; 95% confidence interval [CI], 1.01 to 1.81; P = 0.04). Major, disabling, or life-threatening bleeding (intention-to-treat analysis) had occurred in 46 and 31 patients, respectively (4.3 and 2.8 per 100 person-years; hazard ratio, 1.50; 95% CI, 0.95 to 2.37; P = 0.08). A total of 64 deaths occurred in the rivaroxaban group and 38 in the antiplatelet group (5.8 and 3.4 per 100 person-years, respectively; hazard ratio, 1.69; 95% CI, 1.13 to 2.53). Conclusions: in patients without an established indication for oral anticoagulation after successful TAVR, a treatment strategy including rivaroxaban at a dose of 10 mg daily was associated with a higher risk of death or thromboembolic complications and a higher risk of bleeding than an antiplatelet-based strategy. (Funded by Bayer and Janssen Pharmaceuticals; GALILEO ClinicalTrials.gov number, NCT02556203.)

Sedimentary cycles in a Mesoproterozoic aeolian erg-margin succession: Mangabeira Formation, Espinhaço Supergroup, Brazil

Aeolian systems were abundant and widespread in the early Proterozoic, post-2.2 Ga. However, the majority of aeolian successions of such great age are intensely deformed and are preserved only in a fragmentary state meaning that, hitherto, few attempts have been made to apply a sequence stratigraphic approach to determine mechanisms of aeolian construction, accumulation and preservation in such systems. The Mangabeira Formation is a well preserved Mesoproterozoic erg successions covering part of the São Francisco Craton, northeastern Brazil. The lower unit of the Mangabeira Formation (~ 500 m thick) comprises aeolian deposits of dune, interdune, and sand-sheet origin, as well as some of waterlain origin. These deposits are organized into vertically stacked depositional cycles, each 6 to 20 m thick, and characterized by aeolian sandsheet and waterlain deposits succeeded by aeolian dune and interdune deposits indicative of a drying-upward trend. Aeolian cross-strata exhibit a mean dip direction to the north. Each of these cycles likely arose in response to climatic oscillation from relatively humid to arid conditions, possibly related to orbital forcing. The lower unit of the Mangabeira Formation comprises up to 14 erg sequences. The accumulation and preservation of each was determined by the relative rate of water-table rise and the availability of sand for aeolian transport, both of which changed through time, resulting in the preservation of a succession of repeated drying-upward cycles