Rivaroxaban: An oral direct inhibitor of factor Xa

Gulseth, Michael P.; Michaud, Jessica B.; Nutescu, Edith A.

doi:10.2146/ajhp070624

Cited by 82 publications

(83 citation statements)

References 42 publications

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“…Moreover, these agents can be given in fixed doses and offer a less complex therapeutic regimen for patients (9). These were preferential reasons for initiation of treatment with rivaroxaban.…”

Section: Discussionmentioning

confidence: 99%

“…It is an oral direct, reversible, competitive, rapid, and dose-dependent inhibitor of FXa (9,10). Mechanism of action of rivaroxaban with FXa as its primary target is outlined in Figure 7.…”

Section: Discussionmentioning

confidence: 99%

“…Rivaroxaban (Xarelto®) is an oral, direct, competitive, quick and dose-dependent inhibitor of coagulation factor Xa (FXa) (9,10). From 6 to 23 March the dosage 10 mg in the morning and 20 mg in the evening of rivaroxaban was indicated.…”

Section: Case Reportmentioning

confidence: 99%

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Coincidence of Malignancy and Congenital Thrombophilia as the Cause of Deep Venous Thrombosis - Case Report and Review of the Literature

Stanclakova

Staško

Jedlnakova

et al. 2014

Acta Medica Martiniana

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A b s t r a c t Introduction: Deep venous thrombosis (DVT, phlebothrombosis) is a very important clinical problem with its resultant fatal pulmonary embolism (PE) as one of the possible consequences. Factor V Leiden (FV Leiden) is a genetic disorder characterized by a poor anticoagulant response to activated protein C (APC) and an increased risk of venous thromboembolism (VTE). Homozygous carriers of the FV Leiden mutation are estimated to have an 80-fold increased lifetime relative risk of VTE. Most homozygous carriers present with VTE before 40 years of age, but some can live thrombosis-free until the sixth or seventh decade of life or even remain asymptomatic for life. Case-controlled studies of patients with cancer revealed a four-fold increase in thromboembolic occurrence in acute leukaemia, with the risk of thrombosis persisting even after remission of the disease.Case Report: The authors present a case report of the 61-year-old patient with leukaemic transformation of myelodysplastic syndrome (MDS) to acute myeloid leukaemia (AML) and development of DVT of the left leg (LL) as the first clinical manifestation of homozygous FV Leiden carrier. Due to his diagnosis it was not possible to indicate surgical treatment of DVT. After initial treatment with subcutaneous low molecular weight heparin (LMWH) and continuous intravenous application of unfractionated heparin (UFH) the deficiency of antithrombin III (AT III) potentiating the persistence of his hypercoagulable state developed. Treatment with the new oral anticoagulantrivaroxaban, vasoprotective and antithrombotic drugs in the combination with mechanical methods of VTE prophylaxis led to a reduction in edema of left thigh and calf by 3.5 cm and 4 cm, respectively. Son of the patient experienced DVT at the age of 27 years, too.Conclusion: In this report, we describe a case of the patient with DVT during the leukaemic transformation of MDS to AML as a relatively late first clinical manifestation of homozygous FV Leiden mutation. At the same time the article deals with the clinical aspects of discussed thrombophilia in the relatives of the patient, as well as with the etiopathogenesis, pharmacologic treatment options and possible complications of DVT (PE, pulmonary hypertension and post-thrombotic syndrome).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Coincidence of Malignancy and Congenital Thrombophilia as the Cause of Deep Venous Thrombosis - Case Report and Review of the Literature

Stanclakova

Staško

Jedlnakova

et al. 2014

Acta Medica Martiniana

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“…[11][12][13][14][15]17,[19][20][21][22][23][27][28][29][30][31][32][33][34][35][36][37][38] There is no clinical data for use of rivaroxaban in liver impairment (Child-Pugh class B or C) and its use should be avoided in renal impairment when CrCl ,15 mL/min and NVAF or CrCl ,30 mL/min and VTE management. [19][20][21][22][23][24][25][26] In contrast to dabigatran, rivaroxaban may be given once daily in NVAF and does not require parenteral anticoagulation prior to its use in VTE.…”

Section: Clinical Trialsmentioning

confidence: 99%

Overview of the Direct Oral Anticoagulants

Skeik¹,

Sethi²,

Shepherd³

2017

Journal of the Minneapolis Heart Institute Foundation

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Over the past 6 decades, warfarin has proven efficacious in reducing stroke risk in patients with atrial fibrillation and reducing the risk of recurrent venous thromboembolism in patients with acute deep vein thrombosis or pulmonary embolism. However, there have been multiple challenges with using warfarin including delayed onset of action, need for bridging and monitoring as well as many drug-drug and drug-food interactions. Hence, long years of research have led to the development of direct oral anticoagulants. Of the 4 direct oral anticoagulants currently approved by the Food and Drug Administration, 1 is a direct thrombin inhibitor (dabigatran) and the other 3 are direct factor Xa inhibitors (apixaban, rivaroxaban and edoxaban). Direct oral anticoagulants have been found to be at least as effective as warfarin with fewer bleeding complications. This paper provides an overview of the evolution of anticoagulation therapies and an extensive literature review of the new direct oral anticoagulants. KEY WORDSanticoagulation, direct oral anticoagulant, bleeding n INTRODUCTIONIn the 1920s, cattle in Canada and the northern United States suffered from severe internal bleeding that was associated with diet. It was discovered that spoiled sweet clover hay (Melilotus alba and Melilotus officinalis) contained a hemorrhagic factor, a coumarin compound that was isolated and named dicoumarol, that reduced the activity of prothrombin.1,2 A related derivative, warfarin, was initially used as a rodenticide and eventually moved to clinical application. Warfarin acts as an inhibitor of vitamin K epoxidase reductase, which catalyzes the reduction of oxidized vitamin K.3 The latter is essential for the carboxylation of coagulation proteins for factors II, VII, IX, and X. 4,5 Based on multiple clinical trials, warfarin was proven to reduce stroke risk in patients with atrial fibrillation (AF) and to reduce recurrent venous thromboembolism (VTE) after the initial event.6 However, warfarin has multiple pitfalls including delayed therapeutic onset, interindividual variability in anticoagulant effect, significant drug-drug and drug-food interactions, dietary restrictions, and an increased need for monitoring. 4,7 Research to develop more convenient new anticoagulation therapies with better efficacy and fewer side effects has been ongoing for decades. Based on their mechanism of action, the direct oral anticoagulants (DOACs) can be divided into 2 groups: direct thrombin (factor IIa) and direct FXa inhibitors. 4 The effects of DOAC are seen within a few hours of ingestion, generally require no monitoring, and have fewer drug-drug interactions when compared with warfarin. Furthermore, they have been proven to be at least as effective as warfarin with fewer bleeding complications. 8,9 The Food and Drug Administration (FDA) has approved idarucizumab as a specific antidote to dabigatran and is currently considering andexanet alfa as a reversal agent for the available anti-Xa agents. This paper will review the novel anticoagulant ther...

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“…Following ingestion, the drug is metabolized via oxidative degradation and hydrolysis. The elimination half-life is 5-9 hours [24][25].…”

Section: Factor Xa Inhibitorsmentioning

confidence: 99%

Case files of the medical toxicology fellowship at banner good samaritan medical center in Phoenix, AZ: A non-warfarin anticoagulant overdose

Gresham¹,

Levine²,

Ruha³

2009

J. Med. Toxicol.

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A 50-year-old man presented to the emergency department (ED) following an overdose of his "blood thinners." The patient had become increasingly depressed over financial concerns, prompting a suicide attempt. He declined to provide any details regarding his current medications or his past medical history. A review of the computerized medical record, however, revealed he had a Factor V Leiden mutation with multiple venothromboembolic events. He previously had an inferior vena cava filter placed, and had received tissue plasminogen activator (tPA) for a cerebrovascular accident. A toxicology consult was obtained in the ED.

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Rivaroxaban: An oral direct inhibitor of factor Xa

Abstract: Rivaroxaban is a promising alternative to traditional anticoagulants for the prevention and treatment of venous thromboembolism and for stroke prevention in atrial fibrillation; it offers once-daily oral administration without the need for routine monitoring.

Cited by 82 publications

References 42 publications

Coincidence of Malignancy and Congenital Thrombophilia as the Cause of Deep Venous Thrombosis - Case Report and Review of the Literature

Coincidence of Malignancy and Congenital Thrombophilia as the Cause of Deep Venous Thrombosis - Case Report and Review of the Literature

Overview of the Direct Oral Anticoagulants

Case files of the medical toxicology fellowship at banner good samaritan medical center in Phoenix, AZ: A non-warfarin anticoagulant overdose

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