Tag Archives: rivaroxaban

*citation from Havelock Ellis ‘Impressions and Comments’ Introduction Rivaroxaban is an oral direct factor Xa inhibitor belonging to the novel oral anticoagulants (NOACs) class. Concerning efficacy and tolerability, it has been reported to be more effective than enoxaparin in preventing venous thromboembolism in patients undergoing orthopaedic surgery,1,2 and was non-inferior to enoxaparin followed by warfarin in a study involving patients with established venous thrombosis.3 Its good bioavailability, rapid-action and a half-life of 5–13 h,4 associated with a highly reproducible anticoagulant activity and the same rate of bleeding compl

Summary Oral anticoagulation has been restricted to vitamin K antagonists (VKAs) for more than 50 years. Starting in the last decade of the past century, central coagulation factors such as thrombin and factor Xa were explored as potential targets for the development of novel oral anticoagulants (NOACs). This led to the successful development and approval of a novel class of direct oral anticoagulants targeting factor Xa. Rivaroxaban was the first of the novel class of agents named ‘xabans’ that are direct oral factor Xa inhibitors. Since its initial approval for thromboembolic prophylaxis after hip and knee surgery in 2008, rivaroxaban a

Background The novel oral anticoagulant (NOAC) agents (dabigatran, rivaroxaban, apixaban) have had a disproportionally poor uptake since their respective launches and National Institute for Health and Care Excellence (NICE) Technology Appraisal in the UK between 2012 and 2013 for their use in stroke prevention in patients with non-valvular atrial fibrillation (NVAF), when compared with our European counterparts; particularly Germany, Holland and France. In the original NICE economic analyses for the NOACs there was a calculated uptake of approximately 20% in the first year,1 the figure currently runs at <8% with many area’s significantly

New NICE guidance Dr Andrew Cox (St George’s, University of London) Stroke prevention is the major focus of the new National Institute of Health and Care Excellence (NICE) guidelines on atrial fibrillation (AF), which were discussed by Dr Campbell Cowan (Chair, NICE Guidelines Development Group) in one ‘Hot topics’ session at the meeting. This presentation was in anticipation of the release of the final version of the guidelines a fortnight following the conference. This limited discussion covered the already published draft guidance, but points from this draft which were discussed have since been confirmed in the published guidance

Introduction Atrial fibrillation (AF) affects up to 2% of the population, its prevalence increasing with age; and, with the anticipated rise in the average age of the population, it is likely that the rate of AF will rise considerably. There is a significant risk of stroke, heart failure and mortality associated with AF. Both the National Institute for Health and Care Excellence (NICE) and National Health Service (NHS) Improvement have identified AF and stroke prevention as key areas for maintaining healthcare quality and improvements.1 A key feature is the early identification of patients at risk of thromboembolic events and the prompt init

PREVAIL not presented but eases safety concerns on Watchman The PREVAIL trial of a new device which closes the left atrial appendage in the heart (Watchman®, Boston Scientific) attracted huge controversy at the ACC meeting when it was removed from the programme within an hour of its presentation because of an embargo break by the sponsor, Boston Scientific. But the slides and a press release were still made available to the media, and preliminary results appear to suggest some reassurance on safety concerns generated in a previous study. The device, which is implanted via a trans-septal catheter-based delivery system, is already available in

New editorial board member Dr Ketan Dhatariya We are delighted to welcome Dr Ketan Dhatariya to our editorial board. Dr Dhatariya is a consultant in diabetes, endocrinology and general medicine at Norfolk and Norwich University Hospital, Norwich. He is also a senior lecturer at the University of East Anglia, and an assistant professor of medicine at St George’s University, Grenada, in the West Indies. He has published on a wide variety of diabetes- and endocrine-related subjects, including diabetes-related foot disease. He serves as meetings secretary for the Association of British Clinical Diabetologists, and medical secretary for the Spec

Estimates suggest there will be more than 46,000 cases of acute DVT in England and Wales during 2012, which will rise to nearly 50,000 cases by 2016, due in part to the ageing population. Professor Carole Longson, NICE Health Technology Evaluation Centre Director, said: “For many people, using warfarin is difficult because of the need for regular monitoring with blood tests, dosing adjustments, and the need to be careful about their diet because of warfarin’s interaction with certain foods. Because rivaroxaban does not require frequent blood tests to monitor treatment it represents a potential benefit for many people who have had a DVT, p

NICE updates A new ‘Evidence Update’ has been produced by the National Institute for Health and Clinical Excellence (NICE), which summarises selected new evidence relevant to the NICE guideline on the management of chronic heart failure (CHF) in adults in primary and secondary care (clinical guideline 108).NICE says “Whilst Evidence Updates do not replace current accredited guidance, they do highlight new evidence that might generate a future changes in practice.”  It says it will welcome feedback from societies and individuals in developing this service. The update is available from www.evidence.nhs.uk/evidence-update-2. New guides

Bayer has announced that the oral anticoagulant, rivaroxaban, has reduced ischaemic events but increased bleeding in acute coronary syndrome (ACS) patients in the large-scale trial ATLAS-ACS 2 TIMI 51. The company said the drug was associated with a statistically significant reduction in the primary composite end point of cardiovascular death, myocardial infarction, and stroke versus placebo. However, it was also associated with a significant increase in the primary safety end point: major bleeding events not associated with coronary artery bypass surgery. Bayer says the results will be presented “as soon as possible at a forthcoming scient