Chronic Anticoagulation With a Reduced Dose Regimen of Rivaroxaban in End-stage Renal Disease Patients

Atrial fibrillation is the most frequent cardiac rhythm disorder and its prognosis is essentially marked by the risk of embolic events. Its treatment is based on long-term oral anticoagulant therapy according to the risk of embolic events assessed by risk scores such as the CHA2DS2-Vasc score, but this prescription is associated with a risk of hemorrhagic events that must be taken into consideration when deciding on the treatment for a given patient. There are two categories of validated oral anticoagulant treatments for the prevention of embolic events in atrial fibrillation: antivitamin K agents, which have long been the reference treatment but are restrictive and difficult to use because of a narrow therapeutic window, and direct oral anticoagulants, which are now the first-line treatment but have not been evaluated in phase II and III studies in patients with severe renal failure. End-stage renal disease (clearance \

Inclusion Criteria: * Adult patient ≥ 18 years of age, * Chronic hemodialysis patient for at least 3 months, * Affiliated or beneficiary of a social security plan, * Having signed a written and informed consent. Exclusion Criteria: * Any indication for long-term oral anticoagulation (atrial fibrillation, venous thromboembolic disease, mechanical valve prostheses, intracardiac thrombosis, etc.) * Double anti-platelet aggregation for any reason or an aspirin dose greater than 160 mg/day * Uncontrolled hypertension (BP \> 180/110 mmHg) * Ischemic stroke within 30 days prior to inclusion * History of major unprovoked hemorrhage (leading to hospitalization or transfusion) regardless of age * Surgery within 30 days prior to inclusion * High-risk bleeding condition in addition to renal failure (such as known coagulation disorder, thrombocytopenia (\< 100G/L), active neoplasia of the digestive or urinary tract, or presence of intracranial vascular malformation) * Severe hepatic impairment * Use of strong CYP3A4 inducers, including rifampin, St. John's Wort, carbamazepine, phenytoin, phenobarbital * Non-compliant patients * Pregnant or breastfeeding women, women of childbearing age without effective contraception * Contraindication to the administration of an anticoagulant treatment such as anti-phospholipid antibody syndrome * Known allergy to rivaroxaban or to one of its excipients (lactose monohydrate) * Patients under guardianship or conservatorship * Patients already participating in an ongoing study or who have participated in a study that ended less than 30 days prior to the inclusion date.