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A Journal on Phlebology
Acta Phlebologica 2015 December;16(3):107-9
Does rivaroxaban have a fibrinolytic effect?
Allegra C. 1, Antignani P. L. 2
1 President, Central European Vascular Forum, Rome, Italy;
2 Director, Vascular Center, Nuova Villa Claudia, Rome, Italy
Rivaroxaban is an oral, direct factor Xa inhibitor that inhibits free and clot-bound factor Xa and factor Xa in the prothrombinase complex. Preclinical studies demonstrated a potent anticoagulant effect of rivaroxaban in plasma as well as the ability of this agent to prevent and treat venous and arterial thrombosis in animal models. During the treatment of the patients with DVT we observed the complete recanalization of thrombus after 1-2 weeks. We presented these results during some congresses and other authors refereed the same observation. Aim of this clinical-instrumental observational retrospective research was to evaluate clinically and by means of Echo-color-Duplex the fibrinolytic effect of rivaroxaban in patients with recent and previous DVT. We evaluate two populations of patients: 1st group: 15 patients males (range of age 50-70 years) with previous popliteal-femoral DVT (12-16 months ago) treated with standard anticoagulant therapy. In these patients we found a complete superficial femoral recanalization and partial recanalization of the popliteal vein (30% of residual thrombus). The patients had normal creatinine clearance and liver function. The patients switched from warfarin to rivaroxaban for no compliance to warfarin. 2nd group: 7 patients (range of age 70-85 years), 4 males and 3 females, with previous popliteal-femoral DVT and complete common femoral veins recanalization. The patients presented recent superficial femoral vein rethrombosis (1 week before). The patients had normal creatinine clearance and liver function. In the 1st group we observed in all patients the complete recanalization of the popliteal veins, whereas in the 2nd group: we observed in all patients the complete recanalization of the superficial femoral veins after 2 weeks of the therapy of rivaroxaban and complete recanalization of the popliteal veins after 30 days. No adverse events for both groups were observed. According to our results, we consider that rivaroxaban could have a fibrinolytic effect not only on recent thrombus but also on organized thrombus with, as result, a complete recanalization of affected veins and consequent reduction of incidence of post-thrombotic syndrome saving the valves structure.