Mital Jhaveri: TRACK Trial Findings Highlight the Unique Challenges of Advanced CKD
Mital Jhaveri, Clinical Anticoagulation, Heart Failure Pharmacist at NYC HHC Queens Hospital Center, shared on LinkedIn about a recent article by Sunil V. Badve, published in JAMA, adding:
”New in JAMA: The TRACK Trial examined the impact of low-dose rivaroxaban (2.5 mg BID) on major adverse cardiovascular events in patients with advanced chronic kidney disease (CKD) (Stage 4–5) at high cardiovascular risk.
The findings indicate no benefit and increased harm.
- Primary composite cardiovascular outcome: 22.6% vs. 20.7% (HR 1.09; non-significant)
- Major bleeding: significantly higher in the rivaroxaban arm (8.8%)
- Trial halted early for futility
This study serves as a critical reminder that benefits established in the COMPASS and VOYAGER PAD trials do not apply to advanced CKD, a population with altered hemostatic and pharmacokinetic profiles.
As noted in the accompanying editorial, the TRACK trial should prompt a strategic pivot rather than an abandonment of the inquiry.
Bottom line: Low-dose rivaroxaban should not be used for primary cardiovascular protection in advanced CKD.”
Title: Low-Dose Rivaroxaban and Cardiovascular Events in Advanced Kidney Disease. The TRACK Randomized Clinical Trial
Authors: Sunil V. Badve, Vlado Perkovic, Vivekanand Jha, Raja Ramachandran, Lily Mushahar, Jan Menne, An S. De Vriese, Patrick Rossignol, Adrien Flahault, Maha Al Ammari, Habib Skhiri, Michael Walsh, David Collister, Adrian Liew, Laurent Billot, Severine Bompoint, Anthony Devaux, Min Jun, Enmoore Lin, Aline Ramos da Cruz, Jeffrey T. Ha, John W. Eikelboom, Ahmed Shaman, Meg J. Jardine, Shilpanjali Jesudason, Muh Geot Wong, Craig S. Anderson, Amit X. Garg, Hiddo J. L. Heerspink, Helen Monaghan, Anushka Patel, Patrick B. Mark, David C. Wheeler, Jicheng Lv, Li Zuo, Helen Pilmore, Martin Gallagher
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