Real-world outcomes of rivaroxaban treatment in elderly Japanese patients with nonvalvular atrial fibrillation

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

Research output: Contribution to journalArticle

Abstract

Direct oral anticoagulants (DOACs), such as rivaroxaban, reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (NVAF). However, it is still unclear whether the stroke reduction benefit outweighs the bleeding risk in elderly Japanese patients with NVAF. The Xarelto Post-Authorization Safety and Effectiveness Study in Japanese Patients with Atrial Fibrillation (XAPASS) was a real-world, prospective observational, post-marketing surveillance study on the safety and effectiveness of rivaroxaban in Japanese clinical practice. This sub-analysis evaluated the clinical outcomes of elderly patients aged ≥ 75 years. At the 1-year follow-up, there were 4,685 (48.91%) and 4,893 (51.09%) patients aged ≥ 75 and < 75 years, respectively. Safety and effectiveness outcomes were compared between patients aged ≥ 75 years and those aged < 75 years, and among 3 elderly sub-populations (age ranges: 75–79, 80–84, and ≥ 85 years). Patients aged ≥ 75 years had higher rates of major bleeding [2.22 vs. 1.35 events per 100 patient-years, hazard ratio (HR) 1.63, 95% confidence interval (CI) 1.17–2.28] and composite of stroke (ischemic or hemorrhagic)/non-central nervous system (non-CNS) systemic embolism (SE)/myocardial infarction (MI) (2.41 vs. 1.21 events per 100 patient-years, HR 1.97, 95% CI 1.40–2.77) compared to patients aged < 75 years. Intracranial hemorrhage rates were < 1 event per 100 patient-years in both groups (0.85 vs. 0.59 events per 100 patient-years, HR 1.43, 95% CI 0.85–2.40). Kaplan–Meier curves of major bleeding and stroke/non-CNS SE/MI showed that no significant differences of cumulative event rates were identified among the 3 elderly sub-populations. Stepwise Cox regression analyses revealed that creatinine clearance (CrCl) (<50 mL/min), hepatic impairment, and hypertension were specific predictors for major bleeding and no specific predictors were found for stroke/non-CNS SE/MI in patients aged ≥ 75 years. In conclusion, safety and effectiveness event rates were higher in patients aged ≥ 75 years compared with those aged < 75 years, yet, no distinct differences were observed among the 3 elderly sub-populations.

Original languageEnglish
Pages (from-to)399-408
Number of pages10
JournalHeart and Vessels
Volume35
Issue number3
DOIs
Publication statusPublished - Mar 1 2020

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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    Kitazono, T., Ikeda, T., Ogawa, S., Nakagawara, J., Minematsu, K., Miyamoto, S., Murakawa, Y., Cavaliere, M., Hayashi, Y., Kidani, Y., Okayama, Y., Sunaya, T., Sato, S., & Yamanaka, S. (2020). Real-world outcomes of rivaroxaban treatment in elderly Japanese patients with nonvalvular atrial fibrillation. Heart and Vessels, 35(3), 399-408. https://doi.org/10.1007/s00380-019-01487-x