Rivaroxaban versus enoxaparin/vitamin K antagonist therapy in patients with venous thromboembolism and renal impairment

Thrombosis Journal
Rupert M BauersachsPaolo Prandoni

Abstract

Patients with renal impairment receiving classical anticoagulation for venous thromboembolism (VTE) are at increased risk of bleeding and possibly pulmonary embolism. We examined the efficacy and safety of oral rivaroxaban in patients with VTE with and without renal impairment. Prespecified subgroup analysis of the EINSTEIN DVT and EINSTEIN PE studies comparing fixed-dose rivaroxaban with enoxaparin/a vitamin K antagonist (VKA), performed in 8246 patients enrolled from 2007 to 2011 in 314 hospitals. Outcomes were recurrent VTE and major or clinically relevant nonmajor bleeding in patients with normal renal function (n = 5569; 67.3%) or mild (n = 2037; 24.6%), moderate (n = 636; 7.7%), or severe (n = 21; 0.3%) renal impairment. Rates of recurrent VTE were 1.8%, 2.8%, 3.3%, and 4.8% in patients with normal renal function and mild, moderate, and severe renal impairment, respectively (ptrend = 0.001). Hazard ratios for recurrent VTE were similar between treatment groups across renal function categories (pinteraction = 0.72). Major bleeding in rivaroxaban recipients occurred in 0.8%, 1.4%, 0.9%, and 0%, respectively (ptrend = 0.50). Respective rates in enoxaparin/VKA recipients were 1.0%, 3.0%, 3.9%, and 9.1% (ptrend < 0.001). Rivar...Continue Reading

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Citations

Jun 28, 2017·Therapeutic Advances in Cardiovascular Disease·Alexander G G TurpieAntonio Ciaccia
Sep 4, 2015·Clinical and Applied Thrombosis/hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis·Serena GranzieraAlexander Ander T Cohen
Sep 6, 2018·British Journal of Haematology·Kathrine Parker, Jecko Thachil
Mar 29, 2019·Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis·Alexander T Cohen, Rupert Bauersachs
Sep 30, 2016·Biological Research for Nursing·José Miguel Rivera-CaravacaVanessa Roldán
Apr 11, 2018·Blood Advances·Martin H PrinsJeffrey I Weitz
Aug 22, 2018·Wiener klinische Wochenschrift·Thomas GremmelIngrid Pabinger
Aug 3, 2020·Current Opinion in Nephrology and Hypertension·Thomas A MavrakanasWolfgang C Winkelmayer
Sep 4, 2015·Expert Opinion on Drug Metabolism & Toxicology·Gines EscolarEduardo Arellano-Rodrigo
Oct 21, 2020·Deutsche medizinische Wochenschrift·Joerg Herold, Rupert Bauersachs
Sep 29, 2020·Circulation Journal : Official Journal of the Japanese Circulation Society·Yasuo OkumuraUNKNOWN J’xactly Investigators
Jul 9, 2017·The American Journal of Medicine·John FanikosPaul P Dobesh
Feb 19, 2021·Journal of Clinical Pharmacology·Veronica AshtonKenneth T Moore

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