A new retrospective study in the Cardiology Therapeutics from the Second Affiliated Hospital of Xi’an Jiaotong University has shed light on the clinical outcomes of low-dose rivaroxaban in Chinese patients with nonvalvular atrial fibrillation (NVAF) and normal renal function. Despite international guidelines recommending 15–20 mg/day of rivaroxaban for patients with creatinine clearance (CrCl) ≥ 50 mL/min, low-dose therapy (10 mg/day) has been commonly adopted in China due to concerns over bleeding risk.
The study analyzed 1,455 NVAF patients (mean age: 66.98 years; 55.95% female) treated between January 2017 and June 2022. Patients were divided into two cohorts: standard-dose (15 or 20 mg/day) and low-dose (10 mg/day). Inverse probability of treatment weighting (IPTW) was used to balance the baseline differences, and the risks of ischemic stroke plus systemic embolism (IS+SE) and bleeding events were compared using survival analysis.
In the low-dose group (n=1176), 6.63% experienced IS/SE, and 5.78% had bleeding events. In comparison, 4.66% of patients in the standard-dose group (n=279) experienced IS/SE, and 6.45% had bleeding. Cox regression analysis showed no significant difference in the risk of IS+SE (HR = 1.01, 95% CI: 0.51–1.96, p = 0.999) or bleeding (HR = 0.90, 95% CI: 0.49–1.67, p = 0.749) between the two dosing strategies.
Subgroup analysis demonstrated that in patients with a body mass index (BMI) below 24 kg/m², low-dose rivaroxaban significantly reduced the risk of bleeding (HR = 0.53, 95% CI: 0.29–0.99, p = 0.049).