Effectiveness and Safety of Rivaroxaban Versus Warfarin in Nonvalvular Atrial Fibrillation Patients with Severe Kidney Disease or Undergoing Hemodialysis

Abstract Background Nonvalvular atrial fibrillation patients with stage 4 or 5 chronic kidney disease or undergoing hemodialysis were excluded from phase III randomized trials of nonvitamin K antagonist oral anticoagulants (NOACs). We sought to evaluate the effectiveness and safety of rivaroxaban versus warfarin in nonvalvular atrial fibrillation patients with stage 4 or 5 chronic kidney disease or undergoing hemodialysis in routine practice. Methods Using MarketScan data from 1/2012–12/2017, we identified oral anticoagulant (OAC)-naive nonvalvular atrial fibrillation patients with stage 4 or 5 chronic kidney disease or undergoing hemodialysis and with ≥12-months of insurance coverage before OAC initiation. Differences in baseline covariates between the rivaroxaban and warfarin cohorts were adjusted using inverse probability-of-treatment weights based on propensity scores calculated using generalized boosted models and 10,000 regression trees (absolute standardized differences Results We identified 1896 rivaroxaban (38.7% received a dose Conclusion Among nonvalvular atrial fibrillation patients with stage 4 or 5 chronic kidney disease or undergoing hemodialysis, rivaroxaban appears associated with significantly less major bleeding compared to warfarin.