title: Rivaroxaban in the contemporary treatment of acute coronary syndromes.
abstract: BACKGROUND
  Rivaroxaban is the first orally bioavailable direct factor Xa inhibitor and its role in acute coronary syndrome is not fully understood. A significant residual risk of recurrent ischemia remains in patients with acute coronary syndrome despite optimal medical therapy. Warfarin has demonstrated modest benefit that is offset by the risk of bleeding and complexity in its management. Rivaroxaban may be an attractive agent for the treatment of acute coronary syndromes given its predictable pharmacodynamics and favorable safety profile.
  
  
  METHODS
  The current guideline-based antithrombotic and adjunctive medical therapies in acute coronary syndrome are summarized in this review. Rivaroxaban's drug profile, its current applications, ongoing trials and experience in patients with acute coronary syndrome are also described.
  
  
  CONCLUSIONS
  Current experience of rivaroxaban in acute coronary syndrome demonstrates its safety and a trend towards benefit when added to current optimal medical therapy. The benefits were observed primarily in patients receiving aspirin monotherapy and increased bleeding among those receiving dual anti-platelet therapy. This suggests that there may be a narrow window between the optimal clinically achievable antithrombotic effect and the point where bleeding risk outweighs the benefits. Though promising, it remains to be seen if this drug will achieve the right balance between efficacy and bleeding risk.
authors.affiliation: State University of New York-Stony Brook School of Medicine, Health Sciences Centre Division of Cardiovascular Medicine, T16-080, Stony Brook, NY 11794, USA.
authors.forename: Deepu
authors.initials: D
authors.lastname: Alexander
authors.forename: Allen
authors.initials: A
authors.lastname: Jeremias
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000503:physiopathology; D000284:Administration, Oral; D000818:Animals; D000925:Anticoagulants / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001682:Biological Availability; D065427:Factor Xa Inhibitors; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D009025:Morpholines / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D000069552:Rivaroxaban; D013876:Thiophenes / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D009025:Morpholines; D013876:Thiophenes; D000069552:Rivaroxaban