Dosing of rivaroxaban by indication: getting the right dose for the patient.
BACKGROUND
Vitamin K antagonists were the only oral anticoagulants available for several decades, but they require frequent coagulation monitoring and dose adjustment. The direct oral anticoagulants rivaroxaban , dabigatran, apixaban, and, most recently, edoxaban have been approved for the management of specific thromboembolic indications.


METHODS
This review will provide a brief overview of the cell-based coagulation model, the main determinants of arterial and venous thrombosis, and the pharmacological rationale and clinical evidence for the different dosing regimens of rivaroxaban. Published articles indexed on PubMed and Medline covering arterial and venous thrombi pathophysiology, pharmacokinetics, and pharmacodynamics of rivaroxaban, and Phase II and Phase III clinical studies with rivaroxaban as well as real-world evidence were analyzed.


CONCLUSIONS
Education on pharmacokinetic/pharmacodynamic characteristics, as well as how to manage adverse events, is needed to increase physician knowledge and confidence in using direct oral anticoagulants, as specifically discussed for rivaroxaban in this article. The continued uptake of direct oral anticoagulants in clinical practice depends on understanding of the clinical evidence and reassurance provided by emerging real-world data.
a 1 University of Barcelona, Centre de Diagnostic Biomedic (CDB), Department of Hemotherapy and Hemostasis , Barcelona, Spain +34 9 32 27 54 00, Ext 2571 ; +34 9 32 27 93 69 ; gescolar@clinic.ub.es.
Gines
G
Escolar
b 2 University of Barcelona, Barcelona, Hospital Clinic, Clinical Pharmacology Service , Villarroel 170, Barcelona, Spain.
Xavier
X
Carne
a 1 University of Barcelona, Centre de Diagnostic Biomedic (CDB), Department of Hemotherapy and Hemostasis , Barcelona, Spain +34 9 32 27 54 00, Ext 2571 ; +34 9 32 27 93 69 ; gescolar@clinic.ub.es.
Eduardo
E
Arellano-Rodrigo
D000284:Administration, Oral; D004305:Dose-Response Relationship, Drug; D065427:Factor Xa Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D000069552:Rivaroxaban / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D013923:Thromboembolism / Q000188:drug therapy*
D065427:Factor Xa Inhibitors; D000069552:Rivaroxaban
anticoagulants; pharmacodynamics; pharmacokinetics; rivaroxaban; thrombosis