Journal
JOURNAL OF COMPARATIVE EFFECTIVENESS RESEARCH
Volume 10, Issue 7, Pages 583-593Publisher
FUTURE MEDICINE LTD
DOI: 10.2217/cer-2020-0286
Keywords
atrial fibrillation; dosage; major bleeding; overdosage; rivaroxaban; stroke; underdosage
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In clinical practice, most patients receive the appropriate dosage of rivaroxaban. However, older age and renal insufficiency are associated with inadequate dosing. Underdosed patients had a slightly higher all-cause mortality rate, while overdosed patients had a higher rate of bleeding events.
Aim: To analyze the frequency and variables related to inappropriate rivaroxaban dosage in clinical practice and its impact on outcomes after 2 years. Materials & methods: Postauthorization, observational, multicenter study, in which atrial fibrillation patients, treated with rivaroxaban >= 6 months were included. Results: A total of 1421 patients (74.2 +/- 9.7 years, CHA(2)DS(2)-VASc 3.5 +/- 1.6) were included. Overall, 22.9% received rivaroxaban 15 mg. The proper dose of rivaroxaban was taken by 83.3% (9.7% underdosed, 7.0% overdosed). Older age and renal insufficiency were associated with inadequate rivaroxaban dosage. There was a trend toward higher all-cause mortality among underdosed patients (adjusted hazard ratio 1.39; 95% CI 0.75-2.58), and more bleedings in overdosed patients (2.29 vs 0.80 events/100 patient-years; p = 0.14). Conclusion: In clinical practice, rivaroxaban is properly dosed in most patients.
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