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Reduced doses rivaroxaban and apixaban may be beneficial to reduce renal impairment

ESC 2019
Results from the first observational study using retrospective anonymised data from a German claims database showed that reduced doses of rivaroxaban and apixaban may have a beneficial effect in comparison with phenprocoumon in the outcome of renal function worsening over time. This effect was more pronounced for the risk reduction associated with rivaroxaban in end-stage renal disease (ESRD)/dialysis and specifically also related to a significant risk reduction for acute kidney injury (AKI).

Data on the effectiveness and safety of non-vitamin K oral anticoagulants (NOACs) in patients with non-valvular atrial fibrillation (NVAF) and renal disease is scarce. Bonnemeier and colleagues aimed to investigate the risk of renal function worsening in new users of NOACs vs phenprocoumon. The investicators conducted a new-user cohort study (one year washout period) in patients with NVAF and renal disease, which was defined by either an extended list of ICD10 codes (definition 1) or chronic kidney disease (CKD) stages 3 or 4 (definition 2). German claims data between January 1st, 2013 and June 30th, 2017 were utilised. In total, 22,339 patients initiating rivaroxaban, 16,201 patients initiating apixaban, 2,828 patients initiating edoxaban, and 23,552 patients initiating phenprocoumon were included. NOAC patients with renal disease (definition 1) who initiated reduced doses comprised 2,121 initiators of rivaroxaban, 2,507 of apixaban and 292 of edoxaban. Also, 7,289 patients using phenprocoumon were identified. Patients with CKD (definition 2) initiating reduced doses of NOACs comprised 1,216 initiators of rivaroxaban, 1,522 of apixaban, 166 of edoxaban and 3,513 of phenprocoumon. In the confounder-adjusted analysis, a beneficial effect for both rivaroxaban and apixaban vs phenprocoumon was seen for the risk of ESRD/dialysis for all populations (overall, renal definition 1 and renal definition 2). Furthermore, in the CKD population, a statistically significant risk reduction related to acute kidney injury was only observed for those patients taking rivaroxaban (44%), although insufficient data for edoxaban, limited that analysis [1].

1. Bonnemeier H, et al. Renal function worsening in factor xa inhibitors vs phenprocoumon in patients with nonvalvular atrial fibrillation and renal disease insights from the RELOADED study. Abstract P4749. ESC Congress 2019, 31 Aug-4 Sept, Paris, France.

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