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Rivaroxaban: Practical Considerations for Ensuring Safety and Efficacy
Author(s) -
Smythe Maureen A.,
Fanikos John,
Gulseth Michael P.,
Wittkowsky Ann K.,
Spinler Sarah A.,
Dager William E.,
Nutescu Edith A.
Publication year - 2013
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/phar.1289
Subject(s) - rivaroxaban , medicine , deep vein , pulmonary embolism , warfarin , anticoagulant , thrombosis , stroke (engine) , intensive care medicine , atrial fibrillation , mechanical engineering , engineering
Rivaroxaban is the first agent available within a new class of anticoagulants called direct factor X a inhibitors. Rivaroxaban is approved for use in the U nited S tates for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation, for the prevention of deep vein thrombosis in patients undergoing total hip replacement and total knee replacement, for the treatment of deep vein thrombosis and pulmonary embolism, and for the reduction in risk of recurrence of deep vein thrombosis and pulmonary embolism (with additional indications under review). Rivaroxaban dose and frequency of administration vary depending on the indication. As of result of predictable pharmacokinetics and pharmacodynamics, a fixed dose of rivaroxaban is administered without routine coagulation testing. Rivaroxaban has a short half‐life, undergoes a dual mode of elimination (hepatic and renal), and is a substrate for P ‐glycoprotein. Rivaroxaban has a lower potential for drug interactions compared with warfarin. Despite the advantages of a once/day fixed‐dose oral agent, in many clinical situations limited evidence is available to guide optimal management of rivaroxaban therapy. In this article, we review the available evidence and provide recommendations where possible for such situations including the desire to monitor the anticoagulation intensity, use in special patient populations, managing drug interactions, and transitioning across anticoagulant agents. Potential strategies for reversing rivaroxaban's anticoagulant effect are reviewed. Health systems will need to perform a systematic safety evaluation and ensure that numerous hospital policies related to anticoagulation are updated to include rivaroxaban. A comprehensive approach to education is needed for clinicians, patients, and technical support personnel involved in patient interactions to ensure safe use.