Characterizing major bleeding in patients with nonvalvular atrial fibrillation: a pharmacovigilance study of 27 467 patients taking rivaroxaban.

Journal Article (Journal Article)

BACKGROUND: In nonvalvular atrial fibrillation (NVAF), rivaroxaban is used to prevent stroke and systemic embolism. OBJECTIVE: To evaluate major bleeding (MB) in NVAF patients treated with rivaroxaban in a real-world clinical setting. METHODS: From January 1, 2013, to March 31, 2014, US Department of Defense electronic health care records were queried to describe MB rates and demographics. Major bleeding was identified using a validated algorithm. RESULTS: Of 27 467 patients receiving rivaroxaban, 496 MB events occurred in 478 patients, an incidence of 2.86 per 100 person-years (95% confidence interval: 2.61-3.13). The MB patients were older, mean (SD) age of 78.4 (7.7) vs 75.7 (9.7) years, compared with non-MB patients. Patients with MB had higher rates of hypertension (95.6% vs 75.8%), coronary artery disease (64.2% vs 36.7%), heart failure (48.5% vs 23.7%), and renal disease (38.7% vs 16.7%). Of MB patients, 63.2% were taking 20 mg, 32.2% 15 mg, and 4.6% 10 mg of rivaroxaban. Four percent of MB patients took warfarin within the prior 30 days. Major bleeding was most commonly gastrointestinal (88.5%) or intracranial (7.5%). Although 46.7% of MB patients received a transfusion, none had sufficient evidence of receiving any type of clotting factor. Fourteen died during their MB hospitalization, yielding a fatal bleeding incidence rate of 0.08 per 100 person-years (95% confidence interval: 0.05-0.14). Mean age at death was 82.4 years. CONCLUSIONS: In this large observational study, the MB rate was generally consistent with the registration trial results, and fatal bleeds were rare.

Full Text

Duke Authors

Cited Authors

  • Tamayo, S; Frank Peacock, W; Patel, M; Sicignano, N; Hopf, KP; Fields, LE; Sarich, T; Wu, S; Yannicelli, D; Yuan, Z

Published Date

  • February 2015

Published In

Volume / Issue

  • 38 / 2

Start / End Page

  • 63 - 68

PubMed ID

  • 25588595

Pubmed Central ID

  • PMC6685471

Electronic International Standard Serial Number (EISSN)

  • 1932-8737

Digital Object Identifier (DOI)

  • 10.1002/clc.22373


  • eng

Conference Location

  • United States