title: Rivaroxaban for the treatment of acute coronary syndromes.
abstract: BACKGROUND
  Recurrent ischemic events after an acute coronary syndrome (ACS) are frequent, despite current antiplatelet therapies and revascularization. Warfarin reduces recurrent ischemia but increases bleeding. Warfarin is difficult to administer with the proportion of time achieving therapeutic international normalized ratios varying within and among individuals. The newer oral anticoagulants have predictable dose-effect relationships and no monitoring is required.
  
  
  METHODS
  The pharmacology of rivaroxaban , evidence for the use of rivaroxaban in ACS, and the management of bleeding complications are covered in this article.
  
  
  CONCLUSIONS
  Arterial thrombosis is traditionally thought to be more platelet mediated than clotting factor mediated. Nonetheless, in the acute therapy for ACS, anticoagulation is a cornerstone treatment and there is persistent thrombin generation. Research has focused on finding a "sweet spot" of anticoagulation with high anti-ischemic and low bleeding effects. It follows that with chronic therapy post-ACS, there could also be a "sweet-spot" of anticoagulation. This may depend on the intrinsic vascular disease burden, the intervention delivered (stenting or bypass surgery), and background antiplatelet therapy. Rivaroxaban, a new oral factor Xa inhibitor, in a low-dose regimen-reduced ischemic events including mortality across a broad ACS population in the ATLAS-ACS trial with increased bleeding but without increasing fatal bleeding. Rivaroxaban is an attractive new treatment option for ACS.
authors.affiliation: University of Otago, Dunedin School of Medicine, Dunedin, New Zealand.
authors.forename: Cheuk-Kit
authors.initials: CK
authors.lastname: Wong
authors.forename: Harvey D
authors.initials: HD
authors.lastname: White
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000503:physiopathology; D000925:Anticoagulants / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use*; D017277:Drug Approval; D004347:Drug Interactions; D005060:Europe; D006801:Humans; D009025:Morpholines / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use*; D010980:Platelet Membrane Glycoproteins / Q000037:antagonists & inhibitors; D016032:Randomized Controlled Trials as Topic; D000069552:Rivaroxaban; D013876:Thiophenes / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use*; D014481:United States; D014486:United States Food and Drug Administration
chemical_list: D000925:Anticoagulants; D009025:Morpholines; D010980:Platelet Membrane Glycoproteins; D013876:Thiophenes; C045069:factor X receptors; D000069552:Rivaroxaban