ORIGINAL RESEARCH article
Front. Pharmacol.
Sec. Cardiovascular and Smooth Muscle Pharmacology
Impact of Different Doses of Rivaroxaban on Clinical Outcomes in Elderly Patients with Non-Valvular Atrial Fibrillation: A Real-World Study
Provisionally accepted
- 1The Ninth People's Hospital of Zhengzhou, Zhengzhou, China
- 2The 7th People's Hospital of Zhengzhou, Zhengzhou, China
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Objective: To evaluate associations between rivaroxaban doses and clinical outcomes in elderly non-valvular atrial fibrillation (NVAF) patients in a real-world setting, and identify factors influencing dose selection. Methods: A retrospective analysis included 214 elderly NVAF patients (≥65 years) hospitalized at Zhengzhou Ninth People's Hospital from January to December 2022, all receiving rivaroxaban. Patients were divided into standard-dose (15-20 mg/day) and low-dose (10 mg/day) groups. Clinical outcomes within 12 months post-discharge were collected via follow-up (readmission records, telephone interviews). Results: The low-dose group had a significantly higher mean age (79.2±8.2 vs. 75.4±8.0 years, P=0.001) and bleeding history proportion (21.42% vs. 7.79%, P=0.004) than the standard-dose group. No significant differences were observed in sex (P=0.298), CHA₂DS₂-VASc score (P=0.783), or HAS-BLED score (P=0.586) between groups. Thromboembolic (P=0.308) and bleeding events (P=0.187) showed no statistical differences, but the standard-dose group had a higher 12-month cumulative survival rate (92.3% vs. 88.1%, log-rank P=0.03; unadjusted difference potentially influenced by baseline characteristics). Multivariate logistic regression identified age (OR=0.95, 95% CI:0.91–0.98, P=0.004), bleeding history (OR=0.36, 95% CI:0.14–0.95, P=0.038), and estimated glomerular filtration rate (eGFR, OR=0.99, 95% CI:0.97–1.00, P=0.019) as significant dose selection factors. Conclusion: Low-dose and standard-dose rivaroxaban showed no significant differences in thromboembolic events, bleeding, or all-cause mortality in elderly NVAF patients. While safety profiles were similar, unadjusted analysis linked standard dose to higher survival, potentially confounded by baseline factors (e.g., age, bleeding history). Findings support further research on flexible anticoagulation strategies; age, bleeding history, and renal function should guide individualized treatment.
Keywords: rivaroxaban, Non-valvular atrial fibrillation, elderly patients, Different doses, Real-world study
Received: 27 Sep 2025; Accepted: 18 Nov 2025.
Copyright: © 2025 Yu, Zhang, Yuan, Hu, Li, Huang and Mao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Juan Yu, yujuanqiqi@126.com
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