title: Rivaroxaban in the treatment of venous thromboembolism and the prevention of recurrences: a practical approach.
abstract: Anticoagulation therapy is the standard treatment of patients with symptomatic venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism. Until recently, treatment of VTE was based on parenteral or low-molecular-weight heparin for initial therapy (5-10 days) and oral vitamin K antagonists for long-term therapy. Those treatments have some limitations, including parenteral administration (heparins), the need for frequent monitoring and dose adjustments, interactions with several medications, and dietary restrictions (vitamin K antagonists). Rivaroxaban is a new oral direct factor Xa inhibitor with a wide therapeutic window, predictable anticoagulant effect, no food interactions, and few drug interactions. Consequently, no periodic monitoring of anticoagulation is needed, and fixed doses can be prescribed. EINSTEIN program demonstrated that rivaroxaban was as effective as and significantly safer than standard therapy for treatment of VTE. Rivaroxaban was recently authorized so doubts exist about how to use it in daily clinical practice. This document aims to clarify common questions formulated by clinicians regarding the use of this new drug.
authors.affiliation: Department of Surgery, Hospital Universitario Virgen de las Nieves, Granada, Spain j.arcelus@telefonica.net.
authors.forename: Juan I
authors.initials: JI
authors.lastname: Arcelus
authors.affiliation: Haemostasis and Thrombosis Department. Bellvitge's University Hospital. Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Pere
authors.initials: P
authors.lastname: Domènech
authors.affiliation: Internal Medicine Department, La Paz Universitary Hospital, Autonoma University, Madrid, Spain.
authors.forename: Ma Del Carmen
authors.initials: Mdel C
authors.lastname: Fernández-Capitan
authors.affiliation: Internal Medicine Department, Regional University Hospital of Malaga (Carlos Haya Hospital), Málaga, Spain.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Guijarro
authors.affiliation: Respiratory Department, Ramon y Cajal Hospital, Alcala de Henares University, Madrid, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Jiménez
authors.affiliation: Emergency Department, Hospital Clínic and IDIBAPS, Barcelona, Spain.
authors.forename: Sonia
authors.initials: S
authors.lastname: Jiménez
authors.affiliation: Department of Surgery, Hospital Clínico de Salamanca, Salamanca, Spain.
authors.forename: Francisco S
authors.initials: FS
authors.lastname: Lozano
authors.affiliation: Internal Medicine Department, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.
authors.forename: Manel
authors.initials: M
authors.lastname: Monreal
authors.affiliation: Internal Medicine Service, Hospital Virgen de la Luz, Cuenca, Spain.
authors.forename: José A
authors.initials: JA
authors.lastname: Nieto
authors.affiliation: Hematology Service, Clínica Universidad de Navarra, Pamplona, Spain.
authors.forename: José A
authors.initials: JA
authors.lastname: Páramo
mesh_terms: D004347:Drug Interactions; D016903:Drug Monitoring; D065427:Factor Xa Inhibitors / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D006801:Humans; D012008:Recurrence; D000069552:Rivaroxaban / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D054556:Venous Thromboembolism / Q000097:blood / Q000517:prevention & control*
chemical_list: D065427:Factor Xa Inhibitors; D000069552:Rivaroxaban
keywords: anticoagulants; enoxaparin; heparin; low-molecular-weight; pulmonary embolism; rivaroxaban; venous thromboembolism; venous thrombosis; warfarin