Key result
ABCB1 rs10276036 CT genotype and prior bleeding linked to higher bleeding risk on rivaroxaban.
Why the study?
Rivaroxaban is associated with substantial interindividual variability in bleeding risk, which poses an ongoing clinical challenge.
Do specific pharmacogenetic variants and clinical factors increase the risk of bleeding in Thai patients with atrial fibrillation receiving rivaroxaban?
Case-Control (n=91)
Do specific pharmacogenetic variants and clinical factors increase the risk of bleeding in Thai patients with atrial fibrillation receiving rivaroxaban?
In Thai patients with atrial fibrillation taking rivaroxaban, the ABCB1 rs10276036 CT genotype and prior bleeding history are associated with increased bleeding risk, highlighting the potential for combined genetic and clinical risk stratification.
May inform combined genetic-clinical bleeding risk assessment in Thai AF patients on rivaroxaban; leaves open prospective validation before practice change.
Background: While bleeding is an inherent risk of all anticoagulant therapies, individual susceptibility varies considerably. Rivaroxaban, a direct oral anticoagulant widely used for thromboembolic prevention, is associated with substantial interindividual variability in bleeding risk, posing an ongoing clinical challenge. Objectives: To investigate associations between pharmacogenetic variants in five pharmacokinetic (PK) and nine pharmacodynamic (PD) genes, along with clinical factors, and bleeding outcomes in Thai patients receiving rivaroxaban. Design: A retrospective case–control study was conducted among 91 patients with atrial fibrillation, including 27 who experienced bleeding events. Methods: Genetic variants in PK and PD genes were genotyped using the MassARRAY ® system, and associations between pharmacogenetic variants, clinical factors, and bleeding risk were evaluated using logistic regression analysis. Results: The CT genotype of ABCB1 rs10276036 (C>T) was associated with an increased risk of bleeding. Clinical factors, including prior bleeding history, were also significantly associated with increased bleeding risk. In addition, allele frequency patterns suggested population-specific genetic variation in this Thai cohort. These findings suggest that genetic and clinical factors may jointly contribute to bleeding susceptibility. Conclusion: Bleeding risk in Thai patients receiving rivaroxaban appeared to be influenced by both pharmacogenetic variants, particularly the ABCB1 rs10276036, and established clinical factors. These findings are exploratory and highlight the potential value of integrating genetic and clinical information for risk stratification, pending validation in larger cohorts. Trial registration: As a retrospective non-interventional study, this work was not registered in a clinical trial registry. Ethical approval was obtained (COA No. 1657/2022).
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Yodsurang et al. (2026) conducted a case-control in Atrial fibrillation (n=91). Rivaroxaban was evaluated on Bleeding events. The CT genotype of ABCB1 rs10276036 and prior bleeding history were associated with increased bleeding risk among 91 Thai patients receiving rivaroxaban, of whom 27 experienced bleeding events.
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