Rivaroxaban in the treatment of venous thromboembolism and the prevention of recurrences: a practical approach
Arcelus JI (1), Domènech P (2), Fernández-Capitan Mdel C (3), Guijarro R (4), Jiménez D (5), Jiménez S (6), Lozano FS (7), Monreal M (8), Nieto JA (9), Páramo JA (10).
(1) Department of Surgery, Hospital Universitario Virgen de las Nieves, Granada, Spain
(2) Haemostasis and Thrombosis Department. Bellvitge's University Hospital. Hospitalet de Llobregat, Barcelona, Spain.
(3) Internal Medicine Department, La Paz Universitary Hospital, Autonoma University, Madrid, Spain.
(4) Internal Medicine Department, Regional University Hospital of Malaga (Carlos Haya Hospital), Málaga, Spain.
(5) Respiratory Department, Ramon y Cajal Hospital, Alcala de Henares University, Madrid, Spain.
(6) Emergency Department, Hospital Clínic and IDIBAPS, Barcelona, Spain.
(7) Department of Surgery, Hospital Clínico de Salamanca, Salamanca, Spain.
(8) Internal Medicine Department, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.
(9) Internal Medicine Service, Hospital Virgen de la Luz, Cuenca, Spain.
(10) Hematology Service, Clínica Universidad de Navarra, Pamplona, Spain.
Anticoagulation therapy is the standard treatment of patients with symptomatic venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism.
Until recently, treatment of VTE was based on parenteral or low-molecular-weight heparin for initial therapy (5-10 days) and oral vitamin K antagonists for long-term therapy. Those treatments have some limitations, including parenteral administration (heparins), the need for frequent monitoring and dose adjustments, interactions with several medications, and dietary restrictions (vitamin K antagonists).
Rivaroxaban is a new oral direct factor Xa inhibitor with a wide therapeutic window, predictable anticoagulant effect, no food interactions, and few drug interactions. Consequently, no periodic monitoring of anticoagulation is needed, and fixed doses can be prescribed. EINSTEIN program demonstrated that rivaroxaban was as effective as and significantly safer than standard therapy for treatment of VTE.
Rivaroxaban was recently authorized so doubts exist about how to use it in daily clinical practice. This document aims to clarify common questions formulated by clinicians regarding the use of this new drug.
CITATION Clin Appl Thromb Hemost. 2015 May;21(4):297-308. doi: 10.1177/1076029614561321. Epub 2014 Dec 9.