Kidney Week

Abstract: TH-OR099

Rivaroxaban vs. Warfarin for Prevention of Ischemic Stroke/Systemic Embolism (ISSE) in Patients with Non-Valvular Atrial Fibrillation (NVAF) and Stage 4-5 CKD

Session Information

• Hypertension and CVD: Therapies and Predictors
  November 07, 2019 | Location: 206, Walter E. Washington Convention Center
  Abstract Time: 04:42 PM - 04:54 PM

Category: Hypertension and CVD

• 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention

Authors

• Weir, Matthew R., University of Maryland School of Medicine, Baltimore, Maryland, United States

Matthew R. Weir, MD

Matthew R. Weir, M.D. is attending physician and Director of the Division of Nephrology in the Department of Medicine at the University of Maryland Hospital, Baltimore. He is also Professor of Medicine at the University of Maryland School of Medicine. Dr. Weir’s primary research interests include the use of antihypertensive therapy for the treatment of diabetic nephropathy, hypertensive renal injury in African Americans, cardiovascular disease in patients with chronic kidney disease, and mineralocorticoid receptor antagonism to treat atherosclerosis. He has written more than 600 manuscripts and book chapters about these topics. He has edited 8 books on topics in nephrology, transplantation, and hypertension. He has presented at numerous international scientific association meetings, hospitals, and medical schools. Dr. Weir currently reviews manuscripts for more than 30 major medical journals, including the American Society of Nephrology, and Archives of Internal Medicine. He is on the editorial board of 18 journals and is Section Editor of Current Hypertension Reports and Current Opinion in Hypertension and Nephrology, and Associate Editor of Clinical Nephrology and the American Journal of Nephrology. He has 5 active NIH supported grants: three from NIDDK, and two from NHLBI. In addition, he is a member of numerous associations, including the American Society of Nephrology, the National Kidney Foundation, the American Heart Association, and the American Society of Transplantation. Dr. Weir received his medical degree from the University of Virginia, Charlottesville. He completed his internship and residency programs in medicine at the Waterbury and Yale-New Haven Hospitals in Connecticut, and completed his nephrology training at the Brigham and Women’s Hospital, Harvard Medical School, in Boston, Massachusetts. He then moved to then to the University of Maryland where he has been a full time faculty member since 1983.

• Ashton, Veronica, Janssen Scientific Affairs, Titusville, New Jersey, United States

Veronica Ashton,

• Ammann, Eric M., Mu Sigma, Bangalore, India

Eric M. Ammann,

• Moore, Kenneth Todd, Janssen Medical Affairs, Titusville, New Jersey, United States

Kenneth Todd Moore,

• Shrivastava, Shubham, Mu Sigma, Bangalore, India

Shubham Shrivastava,

• Peterson, Eric D., Duke University School of Medicine, Durham, North Carolina, United States

Eric D. Peterson,

Background

There is limited evidence on the effectiveness and safety of direct-acting oral anticoagulants (DOACs) among patients with NVAF and advanced CKD. This study compared the risks of ISSE and major bleeding in patients with NVAF and stage IV-V CKD treated with rivaroxaban or warfarin.

Methods

Using data from the Optum Deidentified Electronic Health Record (EHR) Database, we selected patients with NVAF and stage IV-V CKD who initiated therapy with rivaroxaban or warfarin from November 1, 2011 through June 30, 2018. Selected patients were required to both be diagnosed with CKD and have an estimated creatinine clearance <30 mL/min and/or evidence of dialysis. Propensity score (PS) matching was used to balance rivaroxaban and warfarin patients on 97 measured baseline covariates. Hospitalizations for ISSE and major bleeding over 2 years following treatment initiation were ascertained with validated endpoint definitions. Outcomes were analyzed as time-to-event data using Kaplan-Meier survival estimators and Cox regression.

Results

781 rivaroxaban patients were PS-matched to 1,536 warfarin patients; after matching, all baseline covariates were well balanced (absolute standardized difference<0.1). The mean patient age was 80 years; 62% were female; 82% and 18% had CKD stage IV and V, respectively. The relative hazard (HR) of ISSE associated with rivaroxaban use compared to warfarin use was 0.93 (95% CI: 0.46, 1.90; p=0.85), and the corresponding HR for major bleeding was 0.91 (95% CI: 0.65, 1.28; p=0.91).

Conclusion

No statistically significant difference in the risk of ISSE or major bleeding was found between patients treated with rivaroxaban or warfarin. While further study is needed, rivaroxaban appears to be a reasonable alternative to warfarin for ISSE prevention in the setting of NVAF and stage IV-V CKD.

Funding

• Commercial Support –