FP305RIVAROXABAN VS WARFARIN AS ORAL ANTICOAGULATION THERAPY IN CKD PATIENTS

Abstract

Introduction and Aims: Atrial fibrillation (AF) represents the most common arrhythmia in patients with chronic kidney disease (CKD) and it is associated with an increased risk of thromboembolism, stroke and bleeding. Oral anticoagulation is the most effective form of thromboprophylaxis and large body of evidence suggests that non-vitamin K-dependent oral anticoagulant agents (NOACs) significantly reduce the risk of stroke, intracranial hemorrhage, and mortality also in stage 1 to 4 CKD patients. Among NOACs, Rivaroxaban present a33% renal clearance and it can be administered at areduced dosage to CKD patients withaeGFR between 15and 49ml/min/1.73 m2. Methods: 248 CKD patients (mean eGFR 37.664 ml/min/1.73 m2) on Rivaroxaban and 101 CKD patients (mean eGFR 38.46 4.5 ml/min/1.73 m2) on warfarin therapy were retrospectively followed in a 15 months follow-up period to evaluate efficacy and safety of both anticoagulant treatment. Main comorbidities were nephroangiosclerosis and unknown glomerulonephritis; no diabetics were enrolled Results: In a15 months follow-upperiod, Rivaroxaban group only showed one major and two minor bleeding, while warfarin group showed higher incidence of major bleeding (15 reports) and hemorragic stroke (8 reports) together with 8 reports of deep venous thromboembolism. All evidences were statistically significant (p < 0.001) Conclusions: Our report clearly shows that NOACs therapy seemstobe both safe and efficient with lower rates of stroke, bleeding and deep venous thromboembolism in respect of warfarin therapy in CKD patients. This could be accountable both to rivarox-aban renal clearance (33%) and stable drug halflife (about 9 hours) across CKD stages (from CKD stage 1 to stage 4).