AIM  To investigate the efficacy and safety of rivaroxaban in patients with non-valvular atrial fibrillation and renal insufficiency.

  METHODS  A total of 297 patients with non-valvular atrial fibrillation and renal insufficiency who were admitted to our hospital from January 2017 to June 2018 were enrolled. By randomized digital table method, the patients were divided into warfarin group (148 cases) and rivaroxaban group (149 cases). Patients in warfarin group were treated with warfarin and patients in rivaroxaban group were treated with rivaroxaban. The coagulation function index, renal function index, survival status, efficacy endpoint event rate and safety endpoint event rate were analyzed and compared between the two groups.

  RESULTS  Before treatment, there was no statistical difference in serum creatinine and creatinine clearance between the two groups, but after treatment, the blood creatinine in both groups was higher than that before treatment and the blood creatinine in warfarin group was higher than that in rivaroxacin group. After treatment, creatinine clearance was lower than that before treatment in both groups, and creatinine clearance in warfarin group was lower than that in rivaroxaban group (P<0.05). The median OS in both groups was 20 months and the risk of death in rivaroxaban group was not significantly different from that in warfarin group (HR = 0.940, 95%CI: 0.714～1.237). In warfarin group, 6 patients had stroke and systemic embolic events and 4 patients in rivaroxaban group had a primary endpoint (HR: 0.650; CI: 0.183～2.303). In warfarin group, 37 patients had major safety events, while 35 patients in rivaroxaban group had major safety events (HR: 0.922, CI: 0.581～1.464).

  CONCLUSION  In patients with non-valvular atrial fibrillation and renal insufficiency, oral rivaroxaban is more effective than warfarin in delaying renal function progression, but there is no significant difference in survival, prevention of stroke, systemic embolism and bleeding events.