, Volume 74, Issue 2, pp 243-262
Date: 16 Jan 2014

Rivaroxaban: A Review of Its Use in the Treatment of Deep Vein Thrombosis or Pulmonary Embolism and the Prevention of Recurrent Venous Thromboembolism

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Abstract

Rivaroxaban (Xarelto®), an oral direct factor Xa inhibitor, is approved for the initial treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), as well as the prevention of recurrent DVT and PE. It is administered at a fixed oral dose and does not require routine coagulation monitoring. In the EINSTEIN-DVT and EINSTEIN-PE trials, in over 8,000 patients with DVT and/or PE, a single-drug approach with rivaroxaban was shown to be noninferior to standard therapy consisting of subcutaneous enoxaparin sodium overlapping with and followed by an oral dose-adjusted vitamin K antagonist (enoxaparin–VKA) with regard to the incidence of symptomatic recurrent venous thromboembolism (VTE) after 3, 6 or 12 months of treatment. Rivaroxaban was generally well tolerated in patients with DVT or PE, with no significant between-group differences in clinically relevant bleeding between the rivaroxaban and enoxaparin–VKA groups. Notably, rivaroxaban was associated with a significantly lower rate of major bleeding compared with enoxaparin–VKA when EINSTEIN-DVT and EINSTEIN-PE data were pooled. Pharmacoeconomic analyses indicated that rivaroxaban may be a cost-effective alternative to enoxaparin–VKA for the treatment of DVT or PE and prevention of recurrent VTE. Extended prophylaxis with rivaroxaban reduced the incidence of symptomatic recurrent VTE to a greater extent than placebo in the EINSTEIN-Extension trial, but was associated with a non-significant increase in the risk of clinically relevant bleeding compared with placebo. In conclusion, rivaroxaban is a reasonable alternative to standard therapy for the treatment of DVT and PE, and as extended thromboprophylaxis.

The manuscript was reviewed by: T.L. Carman, Department of Cardiovascular Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA; A.T. Cohen, Department of Haematological Medicine, King’s College Hospital, London, UK; W. Dietrich, Institute for Research in Cardiac Anesthesia, Munich, Germany; J. Fareed, Departments of Pathology & Pharmacology, Loyola University Chicago, Maywood, IL, USA; J.J. Harenberg, Department of Clinical Pharmacology, University Hospital Mannheim, Mannheim, Germany; A. Squizzato, Research Center on Thromboembolic Disorders and Antithrombotic Therapies, University of Insubria, Varese, Italy