Luca Di Lullo1, Carlo Lavalle2, Michele Magnocavallo3, Marco Valerio Mariani3, Domenico Giovanni Della Rocca4, Paolo Severino3, Biagio Raffaele Di Iorio5, Domenico Russo6, Francesco Summaria7, Giovanni Battista Forleo8, Claudio Ronco9, Massimo Mancone3, Cristina Chimenti3, Fabio Miraldi3, Andrea Natale4, Antonio Bellasi10. 1. Department of Nephrology and Dialysis, L. Parodi - Delfino Hospital, Colleferro, Roma, Italy. 2. Department of Cardiovascular, Respiratory, Nephrology, Anaesthesiology and Geriatric Sciences, "Sapienza" University of Rome, Rome, Italy. Electronic address: carlo.lavalle@uniroma1.it. 3. Department of Cardiovascular, Respiratory, Nephrology, Anaesthesiology and Geriatric Sciences, "Sapienza" University of Rome, Rome, Italy. 4. Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, TX, USA. 5. Nephrology and Dialysis, AORN "San Giuseppe Moscati", 83100 Avellino, Italy. 6. Department of Nephrology, School of Medicine, University "Federico II", 80125 Napoli, Italy. 7. Division of Cardiology, Sant'Eugenio Hospital, Rome, Italy. 8. Department of Cardiology, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milan, Italy. 9. San Bortolo Hospital, Viale Ferdinando Rodolfi, 37, 36100 Vicenza, VI, Italy. 10. Innovation and Brand Reputation Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy.
Abstract
BACKGROUND: Rivaroxaban is a direct inhibitor of activated Factor X (FXa), an anti-inflammatory protein exerting a protective effect on the cardiac valve and vascular endothelium. We compare the effect of Warfarin and Rivaroxaban on inflammation biomarkers and their contribution to heart valve calcification progression and renal preservation in a population of atrial fibrillation (AF) patients with chronic kidney disease (CKD) stage 3b - 4. METHODS: This was an observational, multicenter, prospective study enrolling 347 consecutive CKD stage 3b - 4 patients newly diagnosed with AF: 247 were treated with Rivaroxaban and 100 with Warfarin. Every 12 months, we measured creatinine levels and cardiac valve calcification via standard trans-thoracic echocardiogram, while plasma levels of inflammatory mediators were quantified by ELISA at baseline and after 24 months. RESULTS: Over a follow-up of 24 months, long-term treatment with Rivaroxaban was associated with a significative reduction of cytokines. Patients treated with Rivaroxaban experienced a more frequent stabilization/regression of valve calcifications comparing with patients treated with Warfarin. Rivaroxaban use was related with an improvement in kidney function in 87.4% of patients, while in those treated with Warfarin was reported a worsening of renal clearance in 98% of cases. Patients taking Rivaroxaban experienced lower adverse events (3.2% vs 49%, p-value <0.001). CONCLUSIONS: Our findings suggest that Rivaroxaban compared to Warfarin is associated with lower levels of serum markers of inflammation. The inhibition of FXa may exert an anti-inflammatory effect contributing to reduce the risk of cardiac valve calcification progression and worsening of renal function.
BACKGROUND: Rivaroxaban is a direct inhibitor of activated Factor X (FXa), an anti-inflammatory protein exerting a protective effect on the cardiac valve and vascular endothelium. We compare the effect of Warfarin and Rivaroxaban on inflammation biomarkers and their contribution to heart valve calcification progression and renal preservation in a population of atrial fibrillation (AF) patients with chronic kidney disease (CKD) stage 3b - 4. METHODS: This was an observational, multicenter, prospective study enrolling 347 consecutive CKD stage 3b - 4 patients newly diagnosed with AF: 247 were treated with Rivaroxaban and 100 with Warfarin. Every 12 months, we measured creatinine levels and cardiac valve calcification via standard trans-thoracic echocardiogram, while plasma levels of inflammatory mediators were quantified by ELISA at baseline and after 24 months. RESULTS: Over a follow-up of 24 months, long-term treatment with Rivaroxaban was associated with a significative reduction of cytokines. Patients treated with Rivaroxaban experienced a more frequent stabilization/regression of valve calcifications comparing with patients treated with Warfarin. Rivaroxaban use was related with an improvement in kidney function in 87.4% of patients, while in those treated with Warfarin was reported a worsening of renal clearance in 98% of cases. Patients taking Rivaroxaban experienced lower adverse events (3.2% vs 49%, p-value <0.001). CONCLUSIONS: Our findings suggest that Rivaroxaban compared to Warfarin is associated with lower levels of serum markers of inflammation. The inhibition of FXa may exert an anti-inflammatory effect contributing to reduce the risk of cardiac valve calcification progression and worsening of renal function.
Authors: Carlo Lavalle; Marco Valerio Mariani; Agostino Piro; Michele Magnocavallo; Giampaolo Vetta; Sara Trivigno; Giovanni Battista Forleo; Domenico Giovanni Della Rocca; Massimo Uguccioni; Vincenzo Russo; Francesco Summaria; Luca Di Lullo Journal: J Clin Med Date: 2022-06-04 Impact factor: 4.964