Consider the Whole Patient When Choosing Treatment, Says Dr Marc Bonaca

Patients often have comorbidities that make it important to consider them holistically and not bucket them into one disease state, and the findings on rivaroxaban show broad benefits and a favorable risk-benefit profile, said Marc Bonaca, MD, MPH, executive director of CPC Clinical Research and CPC Community Health and director of vascular research, associate professor of medicine, and the William R. Hiatt Endowed Chair in Cardiovascular Research at the University of Colorado School of Medicine.

Transcript

Why is it important to know that benefits for rivaroxaban are the same regardless of chronic kidney disease (CKD) status?

Clinicians are always struggling with risk-benefit, and we look at trials and then we try to understand how to individualize it to our patients. A lot of clinicians are worried about the patient with comorbid kidney disease about bleeding, and about whether there are different risk-benefit profiles in patients who have PAD [peripheral artery disease] and CKD. And here, we clearly see that there's a very robust benefit and that the bleeding is consistent between the groups, so there's no effect modification for chronic kidney disease.

So, the take home is that the risk-benefit, the favorable risk-benefit for rivaroxaban is entirely consistent with and without chronic kidney disease, and we shouldn’t withhold an effective therapy from this population.

There's been more emphasis in recent years to consider cardiometabolic and renal treatment holistically. How do these new data on rivaroxaban align with that trend?

Well, we have to treat our patients, not disease states. And sometimes we think about, well, this is a kidney patient or peripheral artery patient or coronary patient, but really, these are people. These are patients, and these are family members, and they have all these comorbidities, I think we have to consider holistically the benefits of our therapies and the risks and not put them into buckets.

And so, I think, when I consider therapies in the clinic, I like to think about, what is the holistic benefit? Is it just for MACE [major adverse cardiovascular events]? Is it just for heart failure? Or are there other benefits? And I think we see rivaroxaban is one of those therapies that has broad benefits. That it's not just coronary events, not just stroke, but it's amputation limb events, too. And for the patient with PAD, we have to consider all of those outcomes when we think about therapies.