Oral anticoagulant use in cardiovascular disorders: a perspective on present and potential indications for rivaroxaban

Abstract

Background: Four non-vitamin-K-antagonist oral anticoagulants (NOACs) have been approved for use in various cardiovascular indications. The direct thrombin inhibitor dabigatran and the direct factor Xa inhibitors apixaban, edoxaban and rivaroxaban are now increasingly used in clinical practice. For some of these agents, available data from real-world studies support the efficacy and safety data in phase III clinical trials.

Objectives: This review aims to summarize the current status of trials and observational studies of oral anticoagulant use over the spectrum of cardiovascular disorders (excluding venous thrombosis), provide a reference source beyond stroke prevention for atrial fibrillation (AF) and examine the potential for novel applications in the cardiovascular field.

Methods: We searched the recent literature for data on completed and upcoming trials of oral anticoagulants with a particular focus on rivaroxaban.

Results: Recent data in specific patient subgroups, such as patients with AF undergoing catheter ablation or cardioversion, have led to an extended approval for rivaroxaban, whereas the other NOACs have ongoing or recently completed trials in this setting. However, there are unmet medical needs for several arterial thromboembolic-related conditions, including patients with: AF and acute coronary syndrome, AF and coronary artery disease undergoing elective percutaneous coronary intervention, coronary artery disease and peripheral artery disease, implanted cardiac devices, and embolic stroke of unknown source.

Conclusion: NOACs may provide alternative treatment options in areas of unmet need, and numerous studies are underway to assess their benefit–risk profiles in these settings.

Keywords:

• Direct oral anticoagulant
• factor Xa inhibitor
• lifecycle management
• rivaroxaban

Transparency

Declaration of funding

This work was supported with funding from Bayer AG.

Author contributions: A.J.C. and K.A.A.F. were involved in the conception and development of this review manuscript. Both authors critically reviewed and approved the latest version of this manuscript ahead of submission. A.J.C. and K.A.A.F. agree to be accountable for all aspects of the work.

Declaration of financial/other relationships

A.J.C. has disclosed that he has acted as a consultant to, and received honoraria from, Bayer, Biotronic, Boehringer-Ingelheim, Boston Scientific, Bristol-Myers Squibb, Cardiovascular Therapeutics, Daiichi, Medtronic, Menarini, Mitsubishi, Novartis, Richmond Pharmacology, Sanofi Aventis, Servier, St Jude Medical, Takeda and Xention; has been a member of a speaker bureau for, and received honoraria from, Pfizer. K.A.A.F. has disclosed that he has received grants from Bayer, Janssen, Lilly and AstraZeneca, and honoraria from Bayer, Lilly, Sanofi, Boehringer Ingelheim and AstraZeneca.

A CMRO peer reviewer on this paper declares that they are one of the national coordinators of the GLORIA AF trial. All other CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors would like to acknowledge Claudia Wiedemann from Chameleon Communications International, who provided editorial support with the preparation of the manuscript, with funding from Bayer AG.