Rivaroxaban is an oral direct factor Xa inhibitor in advanced clinical development for the prevention and treatment of thromboembolic disorders. As clinical use increases for this new drug it is important to be aware of factors influencing its clearance and hence anticoagulant potency. This is particularly important in the early part of the clinical use of a new drug, as sponsored clinical trials may have inclusion and exclusion criteria that might tend to be selective for healthier patients.
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The 2009 RGH E-Bulletins are archived here.
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A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.
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The latest RGH E-Bulletin focuses our attention on anticoagulation. With more and more of the population taking anticiagulants understanding the factors for patient variability becomes more important.
The single most major concern in connection to anticoagulant use is the risk of bleeding. Perhaps the biggest driver of this concern is increasing intensity of anticoagulation. Often there is unpredictable variability in patient response to anticoagulant therapy that may inadvertently lead to overanticoagulation and subsequent bleeding.
Most variability in response to warfarin is driven by two genetic elements – the vitamin K epoxidase system, which is the basis for the action of warfarin, and the cytochrome P450 2C9 liver enzymes responsible for warfarin metabolism. As a result, daily maintenance doses can range from 0.5 mg – 20 mg/day.
Read the entire bulletin:
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A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.
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warfarin
The first of the RGH E-Bulletins for 2010 is now out.
Recent evidence shows that the maximum risk is within the first few days after a TIA. One study has shown that for a period of 90 days after a TIA, the risk of stroke is 10.5%, with half of these patients suffering stroke within 48 hours.
Rapid initiation of treatment leads to better outcomes.
The EXPRESS observational study of specialist outpatient TIA management demonstrated that early pharmacotherapy (reducing the median delay to first prescription from 20 days to 1 day) as part of urgent assessment and treatment was associated with a significant lowering of the risk of recurrent stroke at 90 days from 10.3% to 2.1%.
Patients with TIA and associated high -grade carotid stenoses receiving early surgical intervention within two weeks have better secondary stroke prevention outcomes than those receiving later surgery.
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