Bleeding risk lower with rivaroxaban vs warfarin for nonvalvular atrial fibrillation

Rivaroxaban leads to less major bleeding than warfarin when used to treat nonvalvular atrial fibrillation in patients with stage 4 or 5 chronic kidney disease, a recent study has found.

The study included 1,896 rivaroxaban (median age, 72 years; 41.6 percent female) and 4,848 warfarin (median age, 72 years; 38.4 percent female) users, who were followed until the occurrence of stroke/systemic embolism, major bleeding event or discontinuation/switching of medication. Patient groups were matched based on propensity scores. Participants were eligible if they had nonvalvular atrial fibrillation and had stage 4/5 chronic kidney disease or undergoing haemodialysis.

Patients who took rivaroxaban showed a 32-percent less likelihood of developing major bleeding complications relative to their warfarin counterparts (hazard ratio [HR], 0.68, 95 percent CI, 0.47–0.99).

This was driven mostly by between-treatment differences in the risk of intracranial (HR, 0.19, 0.02–1.56) and gastrointestinal (HR, 0.87, 0.58–1.30) bleeding, though neither subtype achieved significance on its own.

The risks of ischaemic stroke (HR, 0.67, 0.30–1.50) or stroke/systemic embolism (HR, 0.55, 0.27–1.10) remained comparable between those who were treated with rivaroxaban and warfarin.

“Despite guideline recommendations, rivaroxaban is used in patients with nonvalvular atrial fibrillation and stage 4 or 5 chronic kidney disease and among those receiving haemodialysis,” said researchers. The present findings revealed that there may not be serious ramifications to this practice.

However, researchers pointed out that “[a]dditional studies are needed to confirm the effectiveness and safety of rivaroxaban in patients with severe kidney dysfunction and to help determine optimal dosing in this population.”