Associations between genetic factors and bleeding in Thai atrial fibrillation patients using rivaroxaban

Andro Ranti, Faculty of Pharmaceutical Sciences

Abstract

Atrial fibrillation (AF) is a common cardiac arrhythmia associated with increased risks of stroke and cardiovascular events. Non-vitamin K antagonist oral anticoagulants (NOACs), such as rivaroxaban, are increasingly used over warfarin for stroke prevention in AF patients, though rivaroxaban use has been linked to bleeding complications. This case-control study investigates clinical and genetic factors contributing to bleeding risk among 90 Thai AF patients on rivaroxaban. Patients were divided into bleeding (case) and non-bleeding (control) groups based on their bleeding experiences while on rivaroxaban. Of the patients studied, 27 experienced bleeding: 13 had major bleeding, 10 had clinically relevant non-major bleeding, and 4 had minor bleeding. Genomic DNA from blood samples was analyzed for single nucleotide polymorphisms (SNPs) in genes related to rivaroxaban pharmacokinetics using MassARRAY®. Logistic regression identified a history of bleeding as significantly associated with bleeding events (OR 17.031, 95% CI: 3.144-92.114, P < 0.01). Among 12 SNPs analyzed, significant differences in bleeding events were observed in ABCB1 polymorphisms, particularly SNP rs1045642 (P < 0.05). These findings suggest the influence of history of bleeding and genetic variation in ABCB1 on bleeding risk in AF patients using rivaroxaban. Further studies are required to validate these results and investigate additional genetic and non-genetic factors affecting bleeding risk.