Xarelto Reduced Risk of Fatal Bleeding for Patients With Renal Disease

Patients with atrial fibrillation and renal disease who were treated with rivaroxaban (Xarelto) had less of a risk of fatal bleeding, according to a study presented at the American Heart Association Scientific Session.

Major bleeding occurs more often in atrial fibrillation patients with renal disease, but when these patients were treated with rivaroxaban, the rate of major fatal bleeding was identical to patients without renal dysfunction (0.09 per 100 person-years for both groups). The incidence of major bleeding was slightly higher (4.52 per 100 person-years) among patients with kidney disease compared with those who did not have kidney disease (2.54 per 100 person-years).

The researchers presumed that the higher rate of major bleeding in the group of patients with renal disease may be a result of the confounding effects of comorbidities, according to Medpage Today.

However, Captain Sally Tamayo, MD, head of cardiology at the Naval Medical Center in Portsmouth, Virginia, said she found it reassuring that the mortality was the same for patients on rivaroxaban with and without renal disease.

The researchers analyzed Department of Defense electronic medical records and identified 44,793 beneficiaries who experienced major bleeding and required hospitalization. Of the 6921 members diagnosed with renal disease, 312 patients experienced major bleeding.

The majority (85%) of the major bleeding occurred in the gut for patients regardless of whether or not they had renal impairment. Patients with renal disease were usually treated with lower doses of rivaroxaban, with half of the group receiving 20 mg daily, 43.5% receiving 15 mg, and 6.2% receiving a 10 mg dose. In comparison, 73% of patients without renal dysfunction were treated with the 20 mg dose, and only 21.1% were given the 15 mg dose.

Douglas Zipes, MD, past president of the American College of Cardiology, told Medpage that the study highlights the link between the heart and the kidney, although the mechanisms are not yet clear as to why patients with heart disease and kidney disease do worse than patients with only heart disease.