Low-Dose Rivaroxaban, Cardiovascular Events, and Kidney Disease—Reply
https://jamanetwork.com/journals/jama/fullarticle/2854849
In Reply TRACK was designed against a background of evidence that rivaroxaban at a dose far lower than required for therapeutic anticoagulation may provide cardiovascular protection with a favorable benefit-risk profile in advanced kidney disease. We agree with Dr Coppi that the results of our trial demonstrated that much of the cardiovascular disease in advanced kidney disease may not be atherothrombotic in nature and therefore may not be modifiable by atherothrombotic treatments. However, we do not concur with other assertions made by Dr Coppi. Patients with advanced kidney disease have been systematically excluded from cardiovascular outcome trials of antiplatelet agents. Observational studies have reported increased mortality with aspirin and clopidogrel use in patients receiving hemodialysis. Until dedicated cardiovascular outcome trials of antiplatelet agents in advanced kidney disease are completed and reported (eg, the Aspirin in Reducing Events in Dialysis [ASPIRED] trial), it is premature to assume that these therapies are safe or beneficial for broad cardiovascular risk reduction in this population.
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