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May 25, 2020Circulation JournalOpen Access

Anti-Factor Xa Activity of Standard and Japan-Specific Doses of Rivaroxaban in Thai Patients With Non-Valvular Atrial Fibrillation

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Key result

Japan-specific rivaroxaban linked to ~36% higher target peak anti-Xa attainment vs standard doses in Thai patients.

  • P=0.001
  • n=60

Why the study?

Lower rivaroxaban doses are approved for SPAF in Japan, but it is unknown whether 15 and 10 mg/day doses are appropriate in other Asian populations.

Do Japan-specific doses of rivaroxaban achieve more appropriate anti-Factor Xa activity compared to standard doses in Thai patients with non-valvular atrial fibrillation?

Comparison

Standard doses (20/15 mg) vs Japan-specific doses (15/10 mg) stratified by renal function

Authors

WWWanwarang WongcharoenPPPhongsathon PacharasupaLNLalita Norasetthada

Discussion

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Overview

Japan-specific rivaroxaban dosing was associated with more expected peak anti-FXa activity in Thai NVAF patients; leaves open impact on clinical outcomes.

Study Design

Type

Observational (n=60)

Structured PICO

Do Japan-specific doses of rivaroxaban achieve more appropriate anti-Factor Xa activity compared to standard doses in Thai patients with non-valvular atrial fibrillation?

P
Population
60 Thai patients with non-valvular atrial fibrillation receiving rivaroxaban, mean age 69.3±9.1 years, mean creatinine clearance 59.2±22.7 mL/min.
I
Intervention
Japan-specific doses of rivaroxaban (15 mg/day for normal renal function, 10 mg/day for reduced renal function)
C
Comparator
Standard doses of rivaroxaban (20 mg/day for normal renal function, 15 mg/day for reduced renal function)
O
Outcome
Anti-Factor Xa (FXa) activity at peak and trough concentrationssurrogate

Main Result

Absolute Event Rate: 87.7% vs 64.4%

p-value: p=0.001

Japan-specific lower doses of rivaroxaban resulted in a significantly higher proportion of Thai patients achieving expected peak anti-FXa activity compared to standard doses.

Cite This Study

Wongcharoen et al. (2020) conducted an observational in Non-valvular atrial fibrillation (n=60). Japan-specific dose of rivaroxaban vs. Standard dose of rivaroxaban (20 and 15 mg/day) was evaluated on Anti-Factor Xa activity at peak concentrations within the expected range (p=0.001). Japan-specific doses of rivaroxaban achieved peak anti-Factor Xa activity within the expected range in more Thai patients than standard doses (87.7% vs. 64.4%; P=0.001).

synapsesocial.com/papers/6a129ddac031bb6829a6fba2https://doi.org/10.1253/circj.cj-20-0056
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Optimal Rivaroxaban Dose in Asian Patients With Atrial Fibrillation and Normal or Mildly Impaired Renal Function2019 · 49 citations
  2. 2The EXPAND study: Efficacy and safety of rivaroxaban in Japanese patients with non-valvular atrial fibrillation2018 · 48 citations
  3. 3Comparisons of Rivaroxaban Following Different Dosage Criteria (ROCKET AF or J‐ROCKET AF Trials) in Asian Patients With Atrial Fibrillation2019 · 30 citations
  4. 4Bleeding risk of apixaban, dabigatran, and low-dose rivaroxaban compared with warfarin in Japanese patients with non-valvular atrial fibrillation: a propensity matched analysis of administrative claims data2017 · 45 citations
  5. 5Factor Xa inhibitors in clinical practice: Comparison of pharmacokinetic profiles2019 · 24 citations