At the 72nd annual American College of Cardiology (ACC) meeting, new real-world data was presented from the XARENO study demonstrating that the new oral anticoagulant (NOAC) Xarelto (rivaroxaban) was associated with a reduced risk of adverse kidney outcomes in patients with non-valvular atrial fibrillation (NVAF) and advanced chronic kidney disease (CKD), compared to vitamin K antagonists (VKAs). These promising findings could point to a potential new standard of care for AF patients with CKD, particularly those with renal failure who typically go undertreated with oral anticoagulation, says GlobalData, a leading data and analytics company.

Amy Murray, Healthcare Analyst at GlobalData comments: “CKD is a frequently encountered comorbidity in patients with AF, with approximately 30% of AF patients diagnosed with advanced CKD. Previous large clinical trials evaluating NOACs for stroke prevention in AF excluded most patients with stage IV and V CKD, thus limiting the evidence base for clinicians to make anticoagulant treatment decisions in this high‐risk population.

“Consequently, warfarin remains the most used treatment option for this AF patient subgroup, despite the numerous shortcomings of the drug class, including the requirement for regular international normalized ratio monitoring and the difficulty in maintaining a high time in the therapeutic range. As such, AF patients with advanced CKD represent a significant yet underserved subgroup of the AF population.”

XARENO marks the first prospective observational study to evaluate the real-world effectiveness and safety of a NOAC versus VKAs in treating patients with NVAF and advanced CKD. The final results of the study demonstrated that rivaroxaban was associated with a reduced risk of adverse kidney outcomes in patients with NVAF and advanced CKD compared to VKAs. All-cause mortality was also significantly reduced in the rivaroxaban treatment group, while no differences were observed between groups for the composite net-clinical benefit.

Murray concludes: “The XARENO study results provide important new evidence that can help physicians in the management of patients with AF and advanced CKD to reduce patients’ risk of progressing to kidney failure. With the potential safety benefits of rivaroxaban compared to VKAs, this NOAC could become a crucial new treatment option for the many AF patients with advanced CKD who, up until now, have typically gone undertreated with oral anticoagulation.”