Miranda Davies 1, 2, Alison Evans 1, 2, Flavien Coukan 1,2 , Lesley Wise1, Saad Shakir 1,2<\/p>\n\n\n\n
Affiliations: 1 Drug Safety Research Unit, 2 University of Portsmouth<\/p>\n\n\n\n
Rivaroxaban is used to treat a range of conditions, including prevention of stroke and systemic embolism in patients with AF. This indication requires a fixed once-daily (od) dose (20mg) with dosage reduction to 15 mg once daily only recommended in patients (pts) with renal impairment (creatinine clearance 15-49 ml\/min). However other clinical factors might be considered by the prescriber when choosing an initial dose.<\/p>\n\n\n\n
To describe the clinical characteristics of pts prescribed an initial dose of (\u2265 20mg and <20 mg daily) for treatment of AF in secondary care.<\/p>\n\n\n\n
The ROSE study was a specialist cohort event monitoring study of pts prescribed rivaroxaban. Specialists provided information from medical records via questionnaires at baseline and \u2265 12 weeks. Information on the prescribed initial dose and baseline characteristics including risk factors for bleeding (HAS-BLED criteria) was collected. For pts prescribed a reduced initial dose (<20 mg daily), we assessed clinical characteristics vs. pts prescribed \u2265 20mg daily.<\/p>\n\n\n\n
The cohort consisted of 965 pts with AF; of whom (18.3%, n=177), were prescribed an initial dose of <20 mg daily (15mg od [n=173]; 10mg od [n=3]; 4mg od [n=1]). The majority were female (57.6%, median age 84 yrs) vs. pts prescribed \u2265 20mg daily (20mg od [n=750]; 30mg od [n=16]), where the majority were male (56.4%, median age 75 yrs). 36\/177 (20.3%) pts had a history of CKD 3-4 or 5. For 22 patients the start dose was unknown. Frequency of HAS-BLED criteria in pts prescribed <20 mg daily vs. \u2265 20mg daily was: Hypertension (37.3% vs. 38.5%), Abnormal renal function (Chronic dialysis, renal transplant, serum creatinine \u2265 2.3 mg\/dL or 200 \u00b5mol\/L) (3.4% vs. 1.2%), Abnormal liver function (0.6% vs. 1.0%), History of Stroke (31.1% vs. 30.4%), History of Bleeding\/predisposition (18.6% vs. 16.3%), Labile INR (N\/A), Age \u226565 yrs (96.1% vs. 81.2%), Drug therapy (52.0% vs. 51.4%), Alcohol (0% vs. 4.8%).<\/p>\n\n\n\n
In pts prescribed a reduced total daily dose of rivaroxaban <20 mg od, there were a higher proportion of females and those aged \u226565 yrs. Patients prescribed this lower dose were also more likely to have abnormal renal function, defined as per HAS-BLED, than those patients prescribed \u2265 20mg daily. Although the label recommends dose reduction in AF pts with renal impairment, other factors seem to impact the choice of the initial dose in the clinical setting.<\/p>\n","protected":false},"featured_media":0,"template":"","meta":{"_acf_changed":false},"categories":[45],"tags":[],"class_list":["post-4815","abstract","type-abstract","status-publish","hentry","category-isop-18th-annual-meeting-geneva-november-2018"],"acf":[],"yoast_head":"\n