Tag Archives: rivaroxaban

Drug therapies include anticoagulants to reduce the risk of stroke and anti-arrhythmics to restore/maintain the normal heart rhythm or slow the heart rate in patients who remain in AF. Non-pharmacological management options include electrical cardioversion, which may be used to ‘shock’ the heart back to its normal rhythm. The high risk of stroke associated with electrical cardioversion can be reduced by oral anticoagulation. Although effective in reducing the risk of thromboembolism, the limitations of warfarin present considerable challenges for its use in clinical practice. The challenges of maintaining warfarin within an appropriate th

Understanding the mechanisms of AF lies at the heart of its treatment. AF occurs when structural and/or electrophysiological abnormalities alter atrial tissue to promote abnormal impulse formation and/or propagation (figure 1).3 Multiple clinical risk factors, electrocardiographic/echocardiographic features and biochemical markers are associated with an increased risk of AF (table 1), and, AF can be described in terms of the duration of episodes using a simplified scheme (table 2).3 Figure 1. Mechanisms of atrial fibrillation Table 1. Risk factors3 The aim of treatment is to prevent stroke and alleviate symptoms.4 Drug therapies include antic

We read with interest Diana Gorog’s recent article on the uptake of non-vitamin K oral anticoagulants (NOACS) in the UK.1 She drew attention to the slow uptake of these agents in the UK as opposed to many countries in Europe, and certainly the USA, and to the role that local medicines management committees (MMCs) may play in this. While the National Institute for Health and Care Excellence (NICE) guidance regarding all three NOACs available in the UK (apixaban, dabigatran and rivaroxaban) is that they should be available as an option for stroke prevention in non-valvular atrial fibrillation (AF), many MMCs in the UK have sought to control p

Cholesterol lowering significantly reduces stroke in the elderly Use of cholesterol lowering drugs (statins and fibrates) is associated with a one third lower risk of stroke in older adults without previous disease, finds a study published in the BMJ. A research team based in France set out to determine the association between use of lipid-lowering drugs in healthy older people and long-term risk of coronary heart disease and stroke. They tracked 7,484 men and women (average age 74 years) with no known history of vascular events, such as heart attacks and strokes, living in three French cities (Bordeaux, Dijon and Montpellier). After an aver

Introduction Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), causes considerable morbidity and mortality.1 VTE is associated with 370,000 deaths per year in the European Union (EU), an estimated 12% of annual deaths.1 The average incidence of VTE in Europe is approximately 160–180 per 100,000 person-years.1 Three large phase III trials with rivaroxaban, a direct factor Xa inhibitor approved for the treatment and prevention of VTE, have provided a strong safety and efficacy evidence base (table 1). The EINSTEIN-DVT study compared rivaroxaban (15 mg twice daily for 21 days, followed by 20 mg on

NICE NOAC guidance The National Institute for Health and Care Excellence (NICE) has recently published two recommendations on the use of novel oral anticoagulants (NOACs). NICE has recommended the NOAC dabigatran as an option for treating and preventing deep-vein thrombosis (DVT) and pulmonary embolism (PE) in adults (available in full at http://www.nice.org.uk/guidance/ta327) A final appraisal determination has also been issued for the NOAC rivaroxaban. It recommends it is an effective treatment option for preventing secondary events after acute coronary syndrome in patients with elevated cardiac biomarkers. Publication of full guidance is e

When the NOACs (novel oral anticoagulants) were introduced over three years ago, they promised to revitalise the management of conditions such as atrial fibrillation (AF), venous thromboembolism (VTE) and thromboprophylaxis after major joint replacement surgery. Rivaroxaban is currently available in multiple indications, including (but not limited to): prevention of stroke and systemic embolism in adult patients with non-valvular AF, treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and the prevention of recurrent DVT and PE in adults. For decades anticoagulant therapy in these conditions had relied on the vitamin K antagon

X-VERT: rivaroxaban▼ an alternative to VKA in cardioversion for AF Watch Professor Keith Fox, Chairman of the ESC programme committee discussing the relevance of X-VERT and other studies for UK practice in our podcast from the ESC Oral anticoagulant therapy with rivaroxaban is an alternative to vitamin K antagonists (VKAs) in patients with AF who are undergoing elective cardioversion according to the results of the X-VERT study.1 In addition, rivaroxaban may potentially have one important advantage over VKAs, with a shorter time to cardioversion, the study suggests. Professor Riccardo Cappato (University of Milan, Italy), the co-principal

ESC guidelines and differences between NOACs Following the roll-out of the novel oral anticoagulants (NOACs), the European Society of Cardiology (ESC) published in 2012 a focused update of its guidelines for the management of atrial fibrillation (AF). Since the NOACs tested in clinical trials all showed at least non-inferiority when compared with vitamin K antagonists (VKAs), with a better safety profile, particularly with reduction in intracranial haemorrhage (ICH), the ESC 2012 guideline recommended NOACs as broadly preferable to VKAs in the vast majority of patients with non-valvular AF (NVAF).1 In 2013, the European Heart Rhythm Associati

Introduction Vitamin K antagonists (VKAs) reduce the risk of stroke in patients with atrial fibrillation (AF). For more than five decades, they were the only available treatment. Novel oral anticoagulants (NOACs) have recently been approved for the prevention of non-valvular AF-related stroke. Dose-adjusted VKA therapy and NOACs are highly effective in AF patients. However, dabigatran, rivaroxaban and apixaban are more convenient, while at least equally effective and with a comparable safety profile (regarding bleeding complications) for stroke prevention compared with VKAs.1-3 Recent guidelines prefer treatment with NOACs over VKAs for most