In Asian atrial fibrillation (AF) patients, low-dose rivaroxaban (Xarelto®, Bayer) has a similar effect on the risk of thromboembolism and bleeding but not on myocardial infarction (MI) when compared to the standard-dose, as shown in a retrospective population-based cohort study from Taiwan.

“Low-dose rivaroxaban (10 mg/day) has been widely used in Asia for patients with atrial fibrillation (AF), although there is a lack of evidence regarding its effectiveness. In Asians, it is unclear whether low-dose rivaroxaban is equally effective as that of the standard dose or is associated with less bleeding risk.”

The retrospective population-based cohort study utilised data files from the National Health Insurance Research Database in the period May 1 2014, to September 30 2015.

In total 6,558 eligible Asian patients with AF or atrial flutter were included in the study; 2,373 took the low-dose (10 mg/day), and 4,185 patients received the standard-dose (15-20 mg/day) rivaroxaban. Patients were followed up until the first manifestation of thromboembolism, bleeding, or myocardial infarction or the pre-defined end of the observation period on December 31, 2015.

Compared to standard-dose rivaroxaban, low-dose rivaroxaban was associated with a similar risk of ischaemic stroke, systemic embolism, major bleeding, and nonmajor but clinically relevant bleeding. However, patients in the low-dose rivaroxaban group had a significantly higher risk of MI (subdistribution HR=2.26; 95% CI, 1.13-4.52).

References

Lin YC, et al. J Am Coll Cardiol 2018: DOI: 10.1016/j.jacc.2018.04.084