Rivaroxaban treatment in patients with chronic kidney disease and atrial fibrillation

Background: In patients with atrial fibrillation (AF) the prevalence of renal dysfunction is high, with approximately 60% having at least moderate impairment. Moreover, among AF patients renal failure is associated with both high risk of thrombotic complications as well as bleedings in those treated with OAC.

Objectives: To compare the characterize and outcomes of AF patients with renal impermeant who were treated with Rivaroxaban versus Warfarin.

Methods: The study included 1,567 patients with non-valvular AF and renal impairment. Inclusion criteria were Rivaroxaban or Warfarin prescription, according to physician discretion and renal impairments defined as eGFR below 60ml/min/BSA. Only patients with appropriately prescribed Rivaroxaban dosage were included. Primary endpoint was 1 year mortality. Secondary endpoint was a composite of mortality, stroke, systemic embolism, major bleeding and myocardial infarction at 1-year.

Results: Mean age of the study population was 77±10 of whom 53% were male. The Warfarin group included 917 (58.5%) patients and the Rivaroxaban group included 650 (41.4%) patients. Patients in the Warfarin group had higher creatinine levels (1.7mg/dl vs. 1.3md/dl, p<0.001), and were more likely to have had heart failure (37% vs. 31%, p=0.02). In contrast, patients in the Rivaroxaban group had significantly more prevalence of diabetes mellitus (40% vs. 33%, p=0.009), hypertension (75% vs. 65%, p<0.001) and higher CHADSVASC score (4.3 vs. 4.1, p=0.036). Kaplan-Meier’s survival analysis showed a significantly lower cumulative probability of 1-year mortality among the Rivaroxaban group (p<0.001). Mortality crude rates discovered similar results (12% vs. 18%, p=0.003), with a trend towards lower rates of the composite endpoint (17% vs. 21%, p=0.11). Multivariate analysis found Rivaroxaban to be associated with 30% reduced risk of mortality (HR 0.7, 95%CI 0.52-0.93, p=0.013).

Conclusions: Appropriately prescribed Rivaroxaban for patients with renal dysfunction and non-valvular AF is associated with improved survival with good efficacy and safety profile compared to Warfarin.