Rivaroxaban - Metabolism, Pharmacologic Properties and Drug Interactions

Kvasnička, Tomáš; Malíková, Ivana; Zenáhlíková, Zuzana; Kettnerova, Karolína; Brzežková, Radka; Zima, Tomáš; Ulrych, Jan; Bríza, J; Netuka, Ivan; Kvasnička, Jan

doi:10.2174/1389200218666170518165443

Cited by 66 publications

(60 citation statements)

References 36 publications

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“…Serum rivaroxaban concentrations increased significantly with a creatinine clearance <50 mL/min. 6,7 We could see that physicians often decided for a reduced dose in patients with eGFR closer to the cut-off value compared with patients receiving doses consistent with the PI. Among patients without a renal indication for dose reduction, the ones who received a reduced dose exhibited worse renal function than those who received a standard dose (mean eGFR 69.1 ± 15.3 mL/min/1.73 m 2 vs 80.5 ± 15.5 mL/min/1.73 m 2 vs) ( Table 2).…”

Section: Predictors Of Rivaroxaban Underdosagementioning

confidence: 99%

“…These recommendations were established in accordance with a pharmacokinetic model in which the creatinine clearance measurement showed a heightened rivaroxaban exposure in correlation with decreased renal functions. Serum rivaroxaban concentrations increased significantly with a creatinine clearance <50 mL/min …”

Section: Introductionmentioning

confidence: 99%

“…Serum rivaroxaban concentrations increased significantly with a creatinine clearance <50 mL/min. 6,7 As suggested by recently registered data, rivaroxaban is commonly dosed inadequately. Such cases occurred among patients with normal as well as insufficient renal function, causing potential over-or underdosing.…”

Section: Introductionmentioning

confidence: 99%

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Initial rivaroxaban dosing in patients with atrial fibrillation

Ablefoni

Buchholz

Ueberham

et al. 2019

Clinical Cardiology

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Background Rivaroxaban is a non‐vitamin K oral anticoagulant and has been approved for prevention of stroke and systemic embolism in patients with non‐valvular atrial fibrillation (AF). Current labeling recommends 20 mg once a day (q.d.) as a standard dose and a reduced dose of 15 mg q.d. in patients with renal impairment. Hypothesis The aim of this study was to analyze the adherence to current labeling concerning initial rivaroxaban dosing and to determine whether potential lack of such adherence is medically justified. Methods Patients with AF initiated on rivaroxaban between January 1, 2016 and January 31, 2017, were identified in the Heart Center Leipzig database. Health records were screened to identify prescribed rivaroxaban dose, presence or absence of renal impairment, patient characteristics, further dosing‐relevant diagnoses and co‐medication with antiplatelet drugs and non‐vitamin K oral anticoagulants (NOACs). Results We identified a total of 378 consecutive patients. In 282 cases (74.6%), rivaroxaban was prescribed in a standard dose and in 96 (25.4%) in a reduced dose. Out of 96 patients receiving a reduced dose, 50 (52.1%) did not meet labeling criteria for dose reduction. In uni‐ and multivariate regression analysis, estimated glomerular filtration rate (eGFR) (odds ratio [OR] 0.34, 95% confidence interval [CI] 0.12‐0.95, P = .04) was the only independent predictor of rivaroxaban underdosage. Conclusions In clinical practice, rivaroxaban dosing is frequently incoherent with labeling. In this study, rivaroxaban was often administered underdosed. Potentially inappropriate dose reduction was significantly associated with eGFR, the same factor that is used as criterion for dose adjustment.

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Section: Predictors Of Rivaroxaban Underdosagementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Initial rivaroxaban dosing in patients with atrial fibrillation

Ablefoni

Buchholz

Ueberham

et al. 2019

Clinical Cardiology

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“…-прямой специфический высокоселективный ин-гибитор Ха-фактора -фермента, выступающего в коагуляционном каскаде в качестве ключевой точки тромбообразования. препарат характеризу-ется быстрым началом действия, высокой биодо-ступностью при пероральном приеме и предсказу-емой фармакокинетикой [18]. апиксабан (регистрация в РФ с 2012 г.)…”

Section: таблица 1/unclassified

Do We Know All About Prevention of Venous Thromboembolism After Major Orthopedic Surgery?

Божкова¹,

Касимова²,

Накопия³

et al. 2018

Traumatology and Orthopedics of Russia

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Venous thromboembolic events including deep venous thrombosis of lower limbs, tromboembolia of the pulmonary artery as well as non-symptomatic venous thromboembolic events are identified via venography and are considered to be potentially life-threatening implications after such major surgeries as total hip and knee arthroplasty. The need for tromboprophylaxis is well realized at present, and there is a wide range of medications with the indication of post-surgical prophylaxis of venous thromboembolic events.In this report the attempt has been made to carry out the comparative analysis of various currently used functional national guidelines on prophylaxis of venous thromboembolic events after total hip and knee arthroplasty. Moreover, having done the research in the systems PubMed (http://www.ncbi.nlm.nih.gov/pubmed, 2007–2017 гг.) and eLIBRARY (http://elibrary.ru, 2007–2017 гг.) the data of the last 10 years of experience in administration of oral anticoagulants has been collected and thoroughly analyzed (dabigatran etexilat, rivaroxaban, apixaban) and antiaggregant (acetylsalicylic acid) in clinical practice, besides comparative data has been also collected based on results obtained from laboratory control of anticoagulative effect of thrombin and x-factor direct inhibitors, even though the opportunities that laboratory control can provide are so far highly limited.At present the efficacy of pharmacological prophylaxis of venous thromboembolic events after total hip and knee arthroplasty is absolutely proven, and the issues concerning the safety of anticoagulants administration are the main focus. These issues frequently require personalized approach to selection of medication for tromboprophylaxis in accordance with the patient’s characteristics and the type of surgery chosen. All these aspects should become the focus for further research.

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“…33 In routine clinical practice, DOACs have simplified therapeutic management of VTE. 34 Indeed, DOACs can be given in fixed doses without routine monitoring and present minimal food and drug interaction. 35 The additional advantage of DOACs is a similarly rapid onset of action to LMWH with oral administration and the safety to switch from VKAs.…”

Section: How To Use Doacs?mentioning

confidence: 99%

Novel Anticoagulant Treatment for Pulmonary Embolism with Direct Oral Anticoagulants Phase 3 Trials and Clinical Practice

Tromeur

Pol

Mairuhu

et al. 2018

Semin intervent Radiol

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Anticoagulant therapy is the cornerstone of therapeutic management in acute venous thromboembolism (VTE), consisting of pulmonary embolism and deep vein thrombosis. Direct oral anticoagulants (DOACs) have become the standard of care because of their good safety profile and ease of use in clinical practice. Indeed, phase 3 randomized trials (AMPLIFY, EINSTEIN, RECOVER, and HOKUSAI studies) showed that DOACs provided a similar efficacy and a better safety than conventional treatment with parenteral heparin with overlapping loading dose of vitamin K antagonists in acute VTE therapeutic management. The results of published data from real-world registries confirm the safety and efficacy of DOACs demonstrated in the phase 3 trials.

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Rivaroxaban - Metabolism, Pharmacologic Properties and Drug Interactions

Cited by 66 publications

References 36 publications

Initial rivaroxaban dosing in patients with atrial fibrillation

Initial rivaroxaban dosing in patients with atrial fibrillation

Do We Know All About Prevention of Venous Thromboembolism After Major Orthopedic Surgery?

Novel Anticoagulant Treatment for Pulmonary Embolism with Direct Oral Anticoagulants Phase 3 Trials and Clinical Practice

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