Two emerging anticoagulants look set to finally make significant in-roads into clinical practice in areas that have long been dominated by warfarin and enoxaparin.
Rivaroxaban is an oral agent that competitively and reversibly inhibits activated Factor Xa. Dabigatran is a competitive reversible antagonist of thrombin. While both appear to offer potential advantages over the current commonly-used anticoagulants such as warfarin and enoxoparin, the efficacy of the two drugs in relation to each other has not yet been tested.
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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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Dabigatran,
RGH E-bulletin,
Rivaroxaban
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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anticoagulation,
factor Xa,
RGH E-bulletin,
Rivaroxaban
The current approach to prophylaxis for venous thromboembolism (VTE) after major orthopaedic surgery of the lower limbs includes the use of warfarin, unfractionated heparin or low molecular weight heparin (refer to e-bulletin vol 31(8)). These require regular monitoring for dosage adjustments, as well as parental administration (in the case of heparin/heparinoids): this can be inconvenient for patients and carers, especially in out-patient settings.
Rivaroxaban (Xarelto®) is a selective direct Factor Xa inhibitor with good oral bioavailability. Factor Xa converts prothrombin to thrombin via the prothrombinase complex. This eventually leads to formation of fibrin clot and platelet activation. Rivaroxaban has a rapid onset of action, a half-life of 5-9 hours and is predominantly renally eliminated.
The complete bulletin can be downloaded here
The 2009 RGH E-Bulletins are archived here.
If you like this post and what else you see on the blog please subscribe by RSS feed (the orange button) or by email. Visit my subscription page.
Tagged as:
RGH E-bulletin,
Rivaroxaban
