Arrhythmias & electrophysiologyMeta-analysis
Comparisons of effectiveness and safety between on-label dosing, off-label underdosing, and off-label overdosing in Asian and non-Asian atrial fibrillation patients treated with rivaroxaban: a systematic review and meta-analysis of observational studies
- Systematic review and meta-analysis of observational studies
- random effects
- adjusted observational studies
Authors' conclusion
Rivaroxaban dosing regimen following J-ROCKET criteria may serve as an alternative to ROCKET AF criteria for the Asian population with NVAF, whereas the dosing regimen following ROCKET AF criteria was more favourable for the non-Asian population. The use of rivaroxaban 10 mg despite of CrCl > 50 mL/min was associated with a higher risk of thromboembolism but a lower risk of major bleeding, while use of rivaroxaban 20 mg despite of CrCl < 50 mL/min was associated with worse outcome in most clinical events.
Study context
- Population
- Asian and non-Asian patients with non-valvular AF treated with rivaroxaban18 studies
- Comparison
- J-ROCKET AF dosing vs ROCKET AF dosing
Pooled result
J-ROCKET AF vs ROCKET AF dosing, by population
Hazard ratio
1.30
95% CI 1.05–1.60
As reported in the abstract
Further pooled results
| Outcome | HR (95% CI) | |
|---|---|---|
| Rivaroxaban 10 mg despite CrCl > 50 mL/min vs eligible dosage, thromboembolism | 1.64 (1.28–2.11) | |
| Rivaroxaban 20 mg despite CrCl < 50 mL/min vs eligible dosage, thromboembolism and mortality — Rivaroxaban 20 mg despite CrCl < 50 mL/min vs eligible dosage · thromboembolism | 1.32 (1.09–1.59) | |
| Rivaroxaban 20 mg despite CrCl < 50 mL/min vs eligible dosage, thromboembolism and mortality — Rivaroxaban 20 mg despite CrCl < 50 mL/min vs eligible dosage · mortality | 1.33 (1.10–1.59) | |
| 0.512Hazard ratio (log scale) |
Safety
| Outcome | HR (95% CI) | |
|---|---|---|
| Major bleeding, off-label dosing vs eligible dosage — Rivaroxaban 10 mg despite CrCl > 50 mL/min vs eligible dosage | 0.72 (0.57–0.90) | |
| Major bleeding, off-label dosing vs eligible dosage — Rivaroxaban 20 mg despite CrCl < 50 mL/min vs eligible dosage | 1.26 (1.03–1.53) | |
| 0.512Hazard ratio (log scale) |
Original publication
Summarised from the published abstract; every number is checked against it