Incomplete Resolution of Deep Vein Thromboses during Rivaroxaban Therapy

Yaghoubian, Jonathan M; Adashek, Jacob J.; Yaghoubian-Yazi, Bahareh; Nagar, Menachem; Toomari, Nojan; Pietras, Richard J.; Ben-Zur, Uri

doi:10.1155/2017/3628127

Cited by 4 publications

(4 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Special patient populations and characteristics that may increase risk of thromboembolic events remain areas for further investigation to confirm efficacy of these agents. [40][41][42][43][44][45] As thrombosis was a secondary endpoint of our study, patientspecific thromboembolic risk factors were not extracted, but should be priority in future studies given these endpoints occurred at a higher than expected rate.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Anti-Xa Apixaban and Rivaroxaban Levels With Respect to Known Doses in Relation to Major Bleeding Events

Nguyen

Ruegger

Salazar

et al. 2021

Journal of Pharmacy Practice

View full text Add to dashboard Cite

Background: Although not routinely recommended, anti-Xa level monitoring for apixaban or rivaroxaban may be useful in certain clinical scenarios. There are currently no laboratory standards, therapeutic ranges, or proven correlation between anti-Xa levels and clinical outcomes. Objective: This study describes the utilization, application, and association of anti-Xa levels with clinical outcomes in patients receiving apixaban or rivaroxaban. Methods: This retrospective, descriptive study included adult inpatients within the Houston Methodist System on apixaban or rivaroxaban with at least one anti-Xa level ordered subsequent to administered doses. The primary endpoint was major bleeding according to International Society on Thrombosis and Haemostasis criteria. Secondary endpoints included reasons for anti-Xa level ordering, anti-Xa levels at different time intervals post-dose, and thrombotic events. Pre-specified subgroup analyses were performed to further evaluate the primary endpoint. Results: The study population consisted of 169 patients and 234 anti-Xa levels. Twenty-nine levels were obtained in context of major bleeding. The majority of levels were not drawn as peak levels 2-4 hours post-dose, however remained quantifiable above typical observed levels within this timeframe and well beyond 24 hours post-dose. Patient characteristics with major bleeding included elderly age, acute renal impairment, and low body weight. At least 14 unique reasons for anti-Xa level ordering were identified. Twenty-nine levels were associated with thrombotic events. Conclusion: Anti-Xa levels may be useful for assessment of current drug concentrations, immediate safety of therapy, and guidance for possible clinical interventions. Dose titration and reversal therapies based on anti-Xa level results in major bleeding warrant further research.

show abstract

Section: Discussionmentioning

confidence: 99%

Evaluation of Anti-Xa Apixaban and Rivaroxaban Levels With Respect to Known Doses in Relation to Major Bleeding Events

Nguyen

Ruegger

Salazar

et al. 2021

Journal of Pharmacy Practice

View full text Add to dashboard Cite

show abstract

“…A thorough literature review revealed only few recent case reports on possible failure of rivaroxaban for the treatment of DVT [1,2] . Furthermore, recommendations on the ranges or cut-offs for effectiveness and efficacy have not yet been confirmed.…”

Section: Discussionmentioning

confidence: 99%

“…Due to the predictable pharmacokinetic and pharmacodynamic outcomes of DOACs, a fixed dose is administered without routine coagulation monitoring. However, data in the literature have shown variability in the anticoagulant effects of DOACs, raising concerns about their effectiveness and safety [1–3] .…”

Section: Introductionmentioning

confidence: 99%

A Low Rivaroxaban Plasma Level May Indicate Anticoagulation Undertreatment

Romano

Chiarugi

Casini

et al. 2018

European Journal of Case Reports in Internal Medicine

View full text Add to dashboard Cite

Few reports have been published on the correlation between plasma concentrations of rivaroxaban and clinical outcome in patients who have experienced venous thromboembolism. This article describes the case of a 44-year-old woman who experienced deep vein thrombosis during anticoagulation therapy with rivaroxaban, with evidence of repeated low plasma levels of the drug. We postulate that the determination of plasma rivaroxaban anti-Xa activity can be useful in the evaluation of anticoagulation therapy in selected cases.LEARNING POINTSSome patients with deep vein thrombosis do not respond to rivaroxaban therapy.Accurate determination of rivaroxaban plasma concentrations is important in clinical practice.The clinical value of rivaroxaban plasma concentrations might be limited by intra- and inter-individual variations.

show abstract

“…Indeed, multiple cases of VTE during the use of DOACs are reported in the literature [9][10][11][12]. Although the number of individual case reports is limited and clearly does not represent the majority of patients using anticoagulants, further exploration is warranted given the potential risk for the individual patient.…”

Section: Demographicsmentioning

confidence: 99%

Thromboembolic Events While Taking Direct Oral Anticoagulants: An Analysis of Post-market WHO Database Reports from 2012 to 2020

et al. 2022

View full text Add to dashboard Cite

Background and Objective Several cases of venous thromboembolism in patients treated with direct oral anticoagulants (DOACs) have been reported in the literature, but a quantative analysis of postmarketing reports is lacking. The objective of this study was to determine the post-marketing odds ratio (OR) and reporting odds ratio (ROR) of venous thromboembolism in patients receiving DOACs compared among each other and to vitamin K antagonists (VKAs). Methods The OR and ROR were used to determine the ratio of reports for deep vein thrombosis and pulmonary embolism between 1 January, 2012 and 15 November, 2020 using the World Health Organization VigiLyze database. This was performed using all venous thromboembolism events in which a DOAC or a VKA was the suspected medication. The OR and ROR including 95% confidence intervals were calculated for each DOAC drug in comparison to all VKAs as a group. ResultsThe OR of deep vein thrombosis was highest for rivaroxaban compared with dabigatran and apixaban [2.63 (2.41-2.89); 1.84 (1.72-1.97)]. The OR of deep vein thrombosis was lowest for edoxaban compared with dabigatran, apixaban and rivaroxaban [0.44 (0.32-0.61); 0.31 (0.22-0.42); 0.17 (0.12-0.23)]. The OR of pulmonary embolism was also highest for rivaroxaban compared with dabigatran and apixaban [2. 59 (2.37-2.83); 1.79 (1.68-1.92)]. The OR of pulmonary embolism was also lowest for edoxaban compared with dabigatran, apixaban and rivaroxaban [0.77 (0.60-0.97); 0.59 (0.41-0.67); 0.30 (0.23-0.37)]. Comparing RORs of various DOACs with VKAs, rivaroxaban had the highest RORs for deep vein thrombosis/ pulmonary embolism, in comparison to apixaban, dabigatran and edoxaban. Conclusions Our findings may indicate a higher association between rivaroxaban therapy and venous thromboembolism as compared with apixaban, dabigatran and edoxaban. These findings are uncertain owing to the reliability of a post-marketing registration system that is negatively influenced by a high level of under-reporting. However, based on pharmacodynamics, we cannot exclude the possibility that there is a real effect that may be driven by non-adherence.

show abstract

Incomplete Resolution of Deep Vein Thromboses during Rivaroxaban Therapy

Cited by 4 publications

References 24 publications

Evaluation of Anti-Xa Apixaban and Rivaroxaban Levels With Respect to Known Doses in Relation to Major Bleeding Events

Evaluation of Anti-Xa Apixaban and Rivaroxaban Levels With Respect to Known Doses in Relation to Major Bleeding Events

A Low Rivaroxaban Plasma Level May Indicate Anticoagulation Undertreatment

Thromboembolic Events While Taking Direct Oral Anticoagulants: An Analysis of Post-market WHO Database Reports from 2012 to 2020

Contact Info

Product

Resources

About