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Albumin and bleed risk in rivaroxaban treated patients

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Abstract

Drugs exhibiting high protein binding have potential increased action in patients with hypoalbuminemia. Rivaroxaban is 92–95% protein bound, but the clinical effects of rivaroxaban in patients with low albumin are largely unknown. The purpose of this study was to evaluate the relationship between albumin and bleeding in rivaroxaban treated patients. This was a retrospective cohort study of hospitalized adults who received rivaroxaban and had an albumin level measured during admission between January and October 2017. Patients who experienced bleeding events while receiving rivaroxaban therapy where compared to those who did not. A multivariable logistic regression model was used to evaluate the association between albumin levels and bleeding events. A total of 368 patients were included; 30 experienced a bleeding event and 338 did not. The mean ± standard deviation albumin level nearest to the time of rivaroxaban initiation was significantly lower in patients who experienced a bleeding event (3.0 ± 0.75 g/dL vs 3.66 ± 0.54 g/dL, p < 0.0001). The multivariable logistic regression model yielded an almost 4.5 fold higher risk of bleeding (adjusted odds ratio 4.405; 95% confidence interval 2.21–9) with any 1 g/dL reduction in albumin. Admission hemoglobin was also associated with bleed risk in the model. Albumin levels were significantly associated with bleed risk in patients receiving rivaroxaban. Albumin levels should be considered when evaluating candidates for rivaroxaban therapy.

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Authors and Affiliations

  1. University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA

    E. Wojakowski

  2. Upstate University Hospital, 750 East Adams Street, Syracuse, NY, 13210, USA

    C. Cheruvil

  3. D’Youville School of Pharmacy, 320 Porter Avenue, Buffalo, NY, 14201, USA

    A. Hassan

  4. University at Buffalo School of Pharmacy and Pharmaceutical Sciences, 205 Pharmacy Building, Buffalo, NY, 14214, USA

    C. Cheruvil, M. R. Holsen, L. Chen, M. Rossi, N. Wilcox & A. E. Woodruff

  5. Buffalo General Medical Center, 100 High Street, Buffalo, NY, 14203, USA

    E. Wojakowski, M. R. Holsen & A. E. Woodruff

  6. AdventHealth Celebration, 400 Celebration Place, Suite A110, Celebration, FL, 34747, USA

    L. Chen

  7. MedStar Union Memorial Hospital, 201 E University Pkwy, Baltimore, MD, 21218, USA

    M. Rossi

Authors
  1. E. Wojakowski
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  2. C. Cheruvil
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  3. A. Hassan
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  4. M. R. Holsen
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  5. L. Chen
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  6. M. Rossi
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  7. N. Wilcox
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  8. A. E. Woodruff
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by EW, CC, AH, LC, MR and AW. The first draft of the manuscript was written by EW, AW, MH and NW and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to A. E. Woodruff.

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Wojakowski, E., Cheruvil, C., Hassan, A. et al. Albumin and bleed risk in rivaroxaban treated patients. J Thromb Thrombolysis 50, 1004–1011 (2020). https://doi.org/10.1007/s11239-020-02092-w

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  • DOI: https://doi.org/10.1007/s11239-020-02092-w

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