Kidney Week

Abstract: PO2377

The Comparative Effectiveness and Safety of Rivaroxaban and Warfarin Initiation in Adults with Atrial Fibrillation (AF) by eGFR Category

Session Information

• CKD: Insights from Recent Clinical Trials and Large Real-World Effectiveness Studies
  November 04, 2021 | Location: On-Demand, Virtual Only
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Ha, Jeffrey, The George Institute for Global Health, Newtown, New South Wales, Australia

Jeffrey Ha, MBBS

• Gallagher, Martin P., The George Institute for Global Health, Newtown, New South Wales, Australia

Martin P. Gallagher,

• Jun, Min, The George Institute for Global Health, Newtown, New South Wales, Australia

Min Jun,

Group or Team Name

• KODIAC-AF Project Team

Background

The risk-benefit ratio of rivaroxaban, a commonly prescribed direct oral anticoagulant, relative to warfarin in patients with atrial fibrillation (AF) and CKD is uncertain.

Methods

We conducted an international multicenter cohort study(2011-2018) using healthcare data from 5 jurisdictions across Australia (530 participants of the 45 and Up Study [among 267153 recruited in 2006-09] with data, accessed via SURE, linked to hospital/laboratory data [by CHeReL] and the Medicare Benefits Schedule and Pharmaceutical Benefits Scheme data provided by Services Australia) and Canada (55038 patients in AB,BC,MB,ON; record linkage of provincial administrative/laboratory data). We propensity score matched adults with a new dispensation of rivaroxaban or warfarin, who had AF and a recorded eGFR grouped as≥60,45-59,30-44 and <30 ml/min/1.73m². Chronic dialysis or kidney transplant recipients were excluded. We assessed 2 composite outcomes within 1 year of initiating either therapy: ischemic (all-cause death, ischemic stroke or transient ischemic attack) and bleeding events (intracranial, gastrointestinal or other). We used Cox regression to estimate the hazard ratios of each outcome across eGFR categories and summarized centre data in random effects meta-analysis.

Results

Of the 55568 matched rivaroxaban and warfarin users, 4733(8.5%) experienced an ischemic event and 1144(2%) a bleeding event. As compared to warfarin initiation, rivaroxaban initiation was associated with lower or similar hazard for the ischemic outcome HR(95% CI) of 0.72(0.66-0.78), 0.82(0.58-1.16), 0.70(0.57-0.87) and 0.78(0.62-0.99), for eGFR ≥60, 45-59, 30-44 and <30ml/min/1.73m² respectively. Rivaroxaban initiation was also associated with lower or similar hazard for the bleeding outcome (0.70[0.49-1.00], 1.00[0.78-1.29], 0.85[0.64-1.12], 0.61[0.35-1.05]). We observed no evidence of heterogeneity across centers except for eGFR 45-59ml/min/1.73m² for the ischemic outcome(I²=77%) and ≥60ml/min/1.73m² for the bleeding outcome(I²=62%).

Conclusion

Compared to warfarin, rivaroxaban initiation was associated with lower or similar risk of both ischemic and bleeding outcomes independent of eGFR. Sufficiently powered randomized trials are needed to confirm findings from this large international cohort.

Funding

• Government Support – Non-U.S.