Despite Clinician Hesitancy, Data Support Use of Rivaroxaban in Patients with PAD, CKD

Mark Svet, MD, is the lead study author on a sub-analysis of the VOYAGER PAD study evaluating data on the use of rivaroxaban in patients with peripheral artery disease (PAD) and chronic kidney disease (CKD).

Pharmacy Times spoke with Mark Svet, MD, at the American College of Cardiology 2022 Scientific Sessions. Svet is the lead study author on a sub-analysis of the VOYAGER PAD study evaluating data on the use of rivaroxaban in patients with peripheral artery disease (PAD) and chronic kidney disease (CKD).

Q: What was the design of the VOYAGER PAD study?

Mark Svet, MD: The Voyager PAD study was a very large, international, multicenter trial that randomized about 6500 patients to receive a dose of rivaroxaban 2 mg twice daily plus aspirin versus aspirin alone, and to follow them longitudinally to look at their rate of irreversible harm to limbs, hearts, or brains.

Q: What were the findings with regard to hospitalizations, and how did this vary within subgroups?

Mark Svet, MD: Yeah, so when you look at the overall trial, this was a pre-specified secondary outcome of hospitalizations and you'll see that rivaroxaban can significantly lower the incidence of rehospitalizations for thromboembolic events. And when you expand that and stratify by their GFR, whether or not they have chronic kidney disease, you see that the benefit was consistent across both those subgroups. Rivaroxaban still reduced those hospitalizations for thrombotic events, but you actually had a higher absolute benefit in those with CKD.

Q: How could these findings change standard treatments for patients with PAD with or without CKD?

Mark Svet, MD: Yeah, I think the biggest thing to emphasize with this trial that we were trying to target was that we have very good therapy in rivaroxaban now for PAD after revascularization. But there's clinician hesitancy to use it sometimes for those who have chronic kidney disease due to increased bleeding risk. This data would hopefully encourage clinicians to not undertreat this patient population as while there is an increased risk of bleeding when using rivaroxaban, the evidence was consistent across those who had or did not have chronic kidney disease.