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July 26, 2026Journal of Thrombosis and Thrombolysis

Disagreement in rivaroxaban dosing between Cockcroft–Gault and eGFR equations in nonvalvular atrial fibrillation: a statewide analysis

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Why the study?

It was unknown whether substituting race-free CKD-EPI 2021 eGFR for Cockcroft-Gault creatinine clearance would alter rivaroxaban dosing recommendations in nonvalvular atrial fibrillation.

Does substituting the CKD-EPI 2021 equation for CG-CrCl-ABW alter rivaroxaban dosing recommendations in adults with nonvalvular atrial fibrillation?

Population

476 adults with NVAF from the Michigan Anticoagulation Quality Improvement Initiative registry

Comparison

Renal function estimated using CG-CrCl-ABW vs CKD-EPI 2021

Design

Retrospective statewide cohort study

Key result

Estimating kidney function using the CKD-EPI 2021 equation resulted in rivaroxaban dosing disagreement in 4.8% of patients compared with the Cockcroft-Gault equation (κ = 0.61; 95% CI 0.47-0.76).

Authors

AAAmina AmmarSESS EdwinGBGeoffrey D. Barnes

Discussion

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Overview

Supports adherence to Cockcroft-Gault labeling for rivaroxaban; leaves open whether CKD-EPI 2021 alters outcomes in NVAF.

Key Points

  • To evaluate discrepancies in rivaroxaban dosing using different kidney function estimation methods in nonvalvular atrial fibrillation.
  • Retrospective statewide cohort study including adults (≥ 18 years) with nonvalvular atrial fibrillation from a registry.
  • Dosing disagreements defined as differences between Cockcroft–Gault creatinine clearance and CKD-EPI 2021 with BSA adjustment.
  • Agreement assessed using Cohen’s kappa.
  • Dosing disagreement occurred in 4.8% of patients after CKD-EPI adjustment, with substantial agreement (κ = 0.61, 95% CI 0.47–0.76).
  • 87.0% of dosing disagreements led to recommended higher rivaroxaban doses.
  • Patients with dosing disagreements had higher CHA2DS2-VASc and HAS-BLED scores, indicating increased stroke and bleeding risks.

Study Design

Type

Cohort (n=476)

Multicenter

Yes

Structured PICO

Does substituting the CKD-EPI 2021 equation for CG-CrCl-ABW alter rivaroxaban dosing recommendations in adults with nonvalvular atrial fibrillation?

P
Population
476 adults (≥ 18 years) with nonvalvular atrial fibrillation from a Michigan statewide registry.
E
Exposure
Rivaroxaban dosing based on renal function estimated using the race-free CKD-EPI 2021 equation with body surface area (BSA) adjustment using the Du Bois formula
C
Comparator
Rivaroxaban dosing based on Cockcroft-Gault creatinine clearance using actual body weight (CG-CrCl-ABW) per FDA labeling
O
Outcome
Rivaroxaban dosing disagreements, defined as a difference in dose between CG-CrCl-ABW and CKD-EPI 2021 with BSA adjustmentsurrogate

Main Result

Effect estimate: κ = 0.61 (95% CI 0.47-0.76)

Using the CKD-EPI 2021 equation instead of Cockcroft-Gault for rivaroxaban dosing in NVAF results in dosing discordance in 4.8% of patients, mostly leading to higher doses, supporting adherence to FDA labeling (CG-CrCl-ABW) until further clinical data is available.

Cite This Study

Ammar et al. (2026) conducted a cohort in nonvalvular atrial fibrillation (NVAF) (n=476). CKD-EPI 2021 equation vs. Cockcroft-Gault equation (CG-CrCl-ABW) was evaluated on rivaroxaban dosing disagreements, defined as a difference in dose between CG-CrCl-ABW and CKD-EPI 2021 with body surface area (BSA) adjustment (κ = 0.61, 95% CI 0.47-0.76). Estimating kidney function using the CKD-EPI 2021 equation resulted in rivaroxaban dosing disagreement in 4.8% of patients compared with the Cockcroft-Gault equation (κ = 0.61; 95% CI 0.47-0.76).

synapsesocial.com/papers/6a65ab38d3aea3239cd794e5https://doi.org/10.1007/s11239-026-03367-4
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