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A Journal on Vascular and Endovascular Surgery
Italian Journal of Vascular and Endovascular Surgery 2015 June;22(2):97-107
Use of rivaroxaban for treatment of venous thromboembolism
Camporese G., Avruscio G.
Unit of Angiology, Department of Cardiac, Thoracic and Vascular Sciences, University Hospital, Padua, Italy
Venous thromboembolism (VTE) is the third most common cardiovascular disease after myocardial infarction and stroke. Immediate and effective VTE treatment is mandatory to reduce the risks of thrombus extension and/or embolization in the early stage of the disease, and to limit the onset of the post-thrombotic syndrome, a complication potentially affecting deep veins of the leg in the late phase of the disease. For many years the standard of VTE therapy has been the association of heparins (unfractionated heparin or low-molecular-weight heparins) or fondaparinux, and the vitamin-K-antagonists (warfarin or acenocumarol). The limitations of these anticoagulant drugs stimulated the development of new anticoagulants. Rivaroxaban is a new oral active anticoagulant directly inhibiting the activated factor X for treatment of venous thromboembolism. The single-drug approach with rivaroxaban for treatment of acute deep-vein thrombosis and pulmonary embolism and for extended secondary prevention of VTE recurrence has been largely investigated along the EINSTEIN program with the EINSTEIN-DVT, EINSTEIN-PE and EINSTEIN-Extension randomized clinical trials. This article will review the pharmacokinetic and pharmacodynamic properties of rivaroxaban, its clinical efficacy and tolerability for the initial treatment of the acute phase of deep-vein thrombosis and pulmonary embolism and for the extended secondary prevention for VTE recurrence. Moreover, some practical considerations for its daily clinical use and the current pros and cons about the indications and the unresolved issues will be reported.