Rivaroxaban demonstrated non-inferiority to standard therapy for recurrent venous thromboembolism prevention (HR 0.89) and reduced major bleeding by 46% in pooled phase III trials.
Does rivaroxaban prevent recurrent VTE in patients with deep vein thrombosis or pulmonary embolism?
Rivaroxaban provides an effective and safe single-drug approach for the acute treatment and secondary prevention of VTE, with a favorable bleeding profile compared to standard therapy.
Patients with deep vein thrombosis or pulmonary embolism are recommended to receive anticoagulation for acute treatment and secondary prevention of venous thromboembolism (VTE). Fast-acting direct oral anticoagulants, with or without parenteral heparin, have the potential to replace vitamin K antagonists in this setting. Rivaroxaban, a direct Factor Xa inhibitor, is approved in the European Union and the United States for the single-drug treatment of deep vein thrombosis and pulmonary embolism and the secondary prevention of recurrent VTE in adults. The approved rivaroxaban dose schedule (15 mg twice daily for 3 weeks followed by 20 mg once daily) was derived based on pharmacological data from the clinical development programme to achieve a strong antithrombotic effect in the acute treatment phase and address the need to balance efficacy and bleeding risk for long-term treatment with a once-daily dose in the maintenance phase. Data from dose-ranging studies, pharmacokinetic modelling and randomised phase III trials support the use of this regimen. Other direct oral anticoagulants have also shown favourable efficacy and safety compared with standard treatment, and apixaban (European Union) and dabigatran (European Union and United States) have been approved in this indication. There are practical aspects to rivaroxaban use that must be considered, such as treatment of patients with renal and hepatic impairment, drug-drug interactions, monitoring of effect and management of bleeding. This review discusses the derivation of the VTE treatment regimen for rivaroxaban, summarises the clinical data for rivaroxaban and other direct oral anticoagulants in VTE treatment, and considers the practical aspects of rivaroxaban use in this setting.
Sebastian Harder (2014) conducted a review in Venous thromboembolism. Rivaroxaban vs. Standard therapy (parenteral anticoagulant overlapped with vitamin K antagonist) was evaluated. Rivaroxaban demonstrated non-inferiority to standard therapy for recurrent venous thromboembolism prevention (HR 0.89) and reduced major bleeding by 46% in pooled phase III trials.
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