Outcomes associated with under-dosing of rivaroxaban for management of non-valvular atrial fibrillation in real-world Japanese clinical settings

Takanori Ikeda, Satoshi Ogawa, Takanari Kitazono, Jyoji Nakagawara, Kazuo Minematsu, Susumu Miyamoto, Yuji Murakawa, Sanghun Iwashiro, Yoko Kidani, Yutaka Okayama, Toshiyuki Sunaya, Shoichiro Sato, Satoshi Yamanaka

Research output: Contribution to journalArticle

Abstract

The approved dose of oral anticoagulant rivaroxaban for patients with non-valvular atrial fibrillation (NVAF) in Japan is 15 mg once daily (od) in patients whose creatinine clearance is ≥ 50 mL/min, but recent real-world studies have demonstrated that these patients often received less than the recommended dose due to bleeding concerns. The effect of under-dosing on safety and effectiveness outcomes remains unclear. We used 1-year follow-up data from the XAPASS, a real-world Japanese prospective, single-arm, observational study. Of the 11,308 patients, 6521 patients who completed a 1-year follow-up and had a creatinine clearance ≥ 50 mL/min were included in this sub-analysis. Primary endpoints were any bleeding and a composite of stroke/non-central nervous system systemic embolism (non-CNS SE)/myocardial infarction (MI). Among the 6521 patients, 4185 (64.2%; mean CHADS2 score: 1.8) received the 15 mg od (recommended dose), whereas 2336 (35.8%; mean CHADS2 score: 2.3) received 10 mg od (under-dose). After adjusting for patient characteristics by propensity scoring and inverse probability of treatment weighting, incidence rates of major bleeding were comparable between under-dosed patients and patients who received the recommended dose (1.34 vs. 1.63 events/100 patient-years, p = 0.197), although the incidence rates of stroke/non-CNS SE/MI were higher in under-dosed patients than in those who received the recommended dose (2.15 vs. 1.48 events/100 patient-years, p = 0.009). In Japanese clinical practice, some NVAF patients receive rivaroxaban doses inconsistent with the recommendation. Considering the total clinical benefit, the recommended dose may be preferable in terms of balance of safety and effectiveness. Clinicaltrials.gov NCT01582737.

Original languageEnglish
Pages (from-to)653-660
Number of pages8
JournalJournal of Thrombosis and Thrombolysis
Volume48
Issue number4
DOIs
Publication statusPublished - Nov 1 2019

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Atrial Fibrillation
Hemorrhage
Embolism
Rivaroxaban
Nervous System
Creatinine
Stroke
Myocardial Infarction
Safety
Incidence
Anticoagulants
Observational Studies
Japan

All Science Journal Classification (ASJC) codes

  • Hematology
  • Cardiology and Cardiovascular Medicine

Cite this

Outcomes associated with under-dosing of rivaroxaban for management of non-valvular atrial fibrillation in real-world Japanese clinical settings. / Ikeda, Takanori; Ogawa, Satoshi; Kitazono, Takanari; Nakagawara, Jyoji; Minematsu, Kazuo; Miyamoto, Susumu; Murakawa, Yuji; Iwashiro, Sanghun; Kidani, Yoko; Okayama, Yutaka; Sunaya, Toshiyuki; Sato, Shoichiro; Yamanaka, Satoshi.

In: Journal of Thrombosis and Thrombolysis, Vol. 48, No. 4, 01.11.2019, p. 653-660.

Research output: Contribution to journalArticle

Ikeda, T, Ogawa, S, Kitazono, T, Nakagawara, J, Minematsu, K, Miyamoto, S, Murakawa, Y, Iwashiro, S, Kidani, Y, Okayama, Y, Sunaya, T, Sato, S & Yamanaka, S 2019, 'Outcomes associated with under-dosing of rivaroxaban for management of non-valvular atrial fibrillation in real-world Japanese clinical settings', Journal of Thrombosis and Thrombolysis, vol. 48, no. 4, pp. 653-660. https://doi.org/10.1007/s11239-019-01934-6
Ikeda, Takanori ; Ogawa, Satoshi ; Kitazono, Takanari ; Nakagawara, Jyoji ; Minematsu, Kazuo ; Miyamoto, Susumu ; Murakawa, Yuji ; Iwashiro, Sanghun ; Kidani, Yoko ; Okayama, Yutaka ; Sunaya, Toshiyuki ; Sato, Shoichiro ; Yamanaka, Satoshi. / Outcomes associated with under-dosing of rivaroxaban for management of non-valvular atrial fibrillation in real-world Japanese clinical settings. In: Journal of Thrombosis and Thrombolysis. 2019 ; Vol. 48, No. 4. pp. 653-660.
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abstract = "The approved dose of oral anticoagulant rivaroxaban for patients with non-valvular atrial fibrillation (NVAF) in Japan is 15 mg once daily (od) in patients whose creatinine clearance is ≥ 50 mL/min, but recent real-world studies have demonstrated that these patients often received less than the recommended dose due to bleeding concerns. The effect of under-dosing on safety and effectiveness outcomes remains unclear. We used 1-year follow-up data from the XAPASS, a real-world Japanese prospective, single-arm, observational study. Of the 11,308 patients, 6521 patients who completed a 1-year follow-up and had a creatinine clearance ≥ 50 mL/min were included in this sub-analysis. Primary endpoints were any bleeding and a composite of stroke/non-central nervous system systemic embolism (non-CNS SE)/myocardial infarction (MI). Among the 6521 patients, 4185 (64.2{\%}; mean CHADS2 score: 1.8) received the 15 mg od (recommended dose), whereas 2336 (35.8{\%}; mean CHADS2 score: 2.3) received 10 mg od (under-dose). After adjusting for patient characteristics by propensity scoring and inverse probability of treatment weighting, incidence rates of major bleeding were comparable between under-dosed patients and patients who received the recommended dose (1.34 vs. 1.63 events/100 patient-years, p = 0.197), although the incidence rates of stroke/non-CNS SE/MI were higher in under-dosed patients than in those who received the recommended dose (2.15 vs. 1.48 events/100 patient-years, p = 0.009). In Japanese clinical practice, some NVAF patients receive rivaroxaban doses inconsistent with the recommendation. Considering the total clinical benefit, the recommended dose may be preferable in terms of balance of safety and effectiveness. Clinicaltrials.gov NCT01582737.",
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AU - Nakagawara, Jyoji

AU - Minematsu, Kazuo

AU - Miyamoto, Susumu

AU - Murakawa, Yuji

AU - Iwashiro, Sanghun

AU - Kidani, Yoko

AU - Okayama, Yutaka

AU - Sunaya, Toshiyuki

AU - Sato, Shoichiro

AU - Yamanaka, Satoshi

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