Rivaroxaban – a selective direct inhibitor of factor Xa

Rivaroxaban – a selective direct inhibitor of factor Xa

Rivaroxaban – a selective direct inhibitor of factor Xa: Rivaroxaban is an anticoagulant that acts by selective direct inhibition of factor Xa. Initially it was approved for prophylaxis of deep vein thrombosis in those undergoing hip and knee joint replacement surgery. Recently it was approved for prevention of stroke in patients with non-valvar atrial fibrillation. As of now, no specific antidote is available for the drug. Important trial of rivaroxaban for the prevention of embolic episodes in atrial fibrillation was ROCKET-AF (Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation) by Manesh R Patel, Kenneth W Mahaffey, Jyotsna Garg, Guohua Pan, Daniel E Singer, Werner Hacke, Günter Breithardt, Jonathan L Halperin, Graeme J Hankey, Jonathan P Piccini, Richard C Becker, Christopher C Nessel, John F Paolini, Scott D Berkowitz, Keith A A Fox and Robert M Califf, the ROCKET AF Investigators [1]. More than fourteen thousand patients were randomized in a double blind fashion to either 20 mg of rivaroxaban once daily or warfarin maintained at a target INR (international normalized ratio of prothrombin time) of 2 to 3. The trial concluded that rivaroxaban was noninferior to warfarin for the prevention of stroke or systemic embolism in patients with atrial fibrillation. There was no significant difference in the risk of major bleeding, though intracranial and fatal bleeding was less frequent with rivaroxaban.

Reference

  1. Manesh R Patel, Kenneth W Mahaffey, Jyotsna Garg, Guohua Pan, Daniel E Singer, Werner Hacke, Günter Breithardt, Jonathan L Halperin, Graeme J Hankey, Jonathan P Piccini, Richard C Becker, Christopher C Nessel, John F Paolini, Scott D Berkowitz, Keith A A Fox, Robert M Califf, ROCKET AF Investigators. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011 Sep 8;365(10):883-91.