Rivaroxaban Benefits LER Patients Safely Regardless of Chronic Kidney Disease

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VOYAGER PAD subgroup analyses showed the anticoagulant reduced likelihood of hospitalization without increasing bleeding risk in patients with CKD.

A subgroup analysis from the VOYAGER PAD trial showed anticoagulant rivaroxaban (Xarelto) was associated with reduced coronary or peripheral events resulting hospitalization among patients with recent lower extremity revascularization (LER), regardless of chronic kidney disease (CKD) status.

The findings, presented at the American College of Cardiology (ACC) 2022 Scientific Sessions in Washington, DC, this weekend, showed rivaroxaban was associated with a 41% reduced risk of primary endpoint hospitalizations versus placebo among patients with CKD—and a 25% reduced risk among patients without CKD.

Additionally, investigators observed consistent bleeding risk with the anticoagulant therapy regardless of baseline CKD status.

In an interview regarding the findings, study author Mark Svet, MD, internal medicine resident at the University of Colorado Anschutz School of Medicine, discussed the impetus of VOYAGER PAD analysis into patient CKD status.

“What we realized when we were looking through some of the data and the outcomes we previously had is that there wasn’t a lot of data expanding on readmission and re-hospitalization rates,” Svet said, “which we thought was a key opportunity because you have a medication that’s cleared renally, and we already know that individuals with kidney disease have increased bleeding rates, but there’s also a clear benefit to the medication.”

Svet also discussed the general clinical concern of bleeding risk in prescribing anticoagulants, especially among perceivably greater-risk patients with kidney disease.

“Any time you’re dealing with anticoagulants, there’s the corresponding bleeding risk, and it’s a benefit-risk conversation,” he said. “And I would hope that as more data come out in testing these agents in patients with underlying renal disease, you see that while yes, bleeding is increased, it’s not necessarily dependent on their underlying renal function, that that should be encouraging and reassuring for these prescribers to get it out there.”

The study, “Rivaroxaban Reduces Hospitalizations for Thromboembolic Events in Patients With Peripheral Artery Disease After Revascularization in Those With And Without Chronic Kidney Disease,” was presented at ACC 2022.