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July 26, 2026Journal of Thrombosis and Thrombolysis

Disagreement in rivaroxaban dosing between Cockcroft–Gault and eGFR equations in nonvalvular atrial fibrillation: a statewide analysis

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Why the study?

Does substituting the CKD-EPI 2021 equation for CG-CrCl-ABW alter rivaroxaban dosing recommendations in adults with nonvalvular atrial fibrillation?

Population

476 adults with nonvalvular atrial fibrillation identified from the Michigan Anticoagulation Quality…

Comparison

Rivaroxaban dosing based on renal function… vs Rivaroxaban dosing based on Cockcroft-Gault…

Design

Cohort

Key result

Estimating kidney function using the CKD-EPI 2021 equation resulted in rivaroxaban dosing disagreement in 4.8% of patients compared with the Cockcroft-Gault equation (κ = 0.61; 95% CI 0.47-0.76).

Authors

AAAmina AmmarSESS EdwinGBGeoffrey D. Barnes

Discussion

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Overview

Supports adherence to Cockcroft-Gault labeling for rivaroxaban; leaves open whether CKD-EPI 2021 alters outcomes in NVAF.

Key Points

  • To evaluate discrepancies in rivaroxaban dosing using different kidney function estimation methods in nonvalvular atrial fibrillation.
  • Retrospective statewide cohort study including adults (≥ 18 years) with nonvalvular atrial fibrillation from a registry.
  • Dosing disagreements defined as differences between Cockcroft–Gault creatinine clearance and CKD-EPI 2021 with BSA adjustment.
  • Agreement assessed using Cohen’s kappa.
  • Dosing disagreement occurred in 4.8% of patients after CKD-EPI adjustment, with substantial agreement (κ = 0.61, 95% CI 0.47–0.76).
  • 87.0% of dosing disagreements led to recommended higher rivaroxaban doses.
  • Patients with dosing disagreements had higher CHA2DS2-VASc and HAS-BLED scores, indicating increased stroke and bleeding risks.

Study Design

Type

Cohort (n=476)

Multicenter

Yes

Structured PICO

Does substituting the CKD-EPI 2021 equation for CG-CrCl-ABW alter rivaroxaban dosing recommendations in adults with nonvalvular atrial fibrillation?

P
Population
476 adults (≥ 18 years) with nonvalvular atrial fibrillation from a Michigan statewide registry.
E
Exposure
Rivaroxaban dosing based on renal function estimated using the race-free CKD-EPI 2021 equation with body surface area (BSA) adjustment using the Du Bois formula
C
Comparator
Rivaroxaban dosing based on Cockcroft-Gault creatinine clearance using actual body weight (CG-CrCl-ABW) per FDA labeling
O
Outcome
Rivaroxaban dosing disagreements, defined as a difference in dose between CG-CrCl-ABW and CKD-EPI 2021 with BSA adjustmentsurrogate

Main Result

Effect estimate: κ = 0.61 (95% CI 0.47-0.76)

Using the CKD-EPI 2021 equation instead of Cockcroft-Gault for rivaroxaban dosing in NVAF results in dosing discordance in 4.8% of patients, mostly leading to higher doses, supporting adherence to FDA labeling (CG-CrCl-ABW) until further clinical data is available.

Cite This Study

Ammar et al. (2026) conducted a cohort in nonvalvular atrial fibrillation (NVAF) (n=476). CKD-EPI 2021 equation vs. Cockcroft-Gault equation (CG-CrCl-ABW) was evaluated on rivaroxaban dosing disagreements, defined as a difference in dose between CG-CrCl-ABW and CKD-EPI 2021 with body surface area (BSA) adjustment (κ = 0.61, 95% CI 0.47-0.76). Estimating kidney function using the CKD-EPI 2021 equation resulted in rivaroxaban dosing disagreement in 4.8% of patients compared with the Cockcroft-Gault equation (κ = 0.61; 95% CI 0.47-0.76).

synapsesocial.com/papers/6a65ab38d3aea3239cd794e5https://doi.org/10.1007/s11239-026-03367-4
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