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Abstract
Introduction: The increasing and widespread use of direct oral anticoagulants (DOACs) demands guidelines and experts’ consensus for their rational and safe use, especially in certain situations for which there is no evidence-based consensus, such as the periprocedural setting. Rivaroxaban is an oral factor Xa inhibitor approved for stroke prevention in atrial fibrillation (AF) and for treatment and prevention of venous thromboembolism (VTE) in major orthopedic surgery. This article is addressed to all the clinicians involved in the periprocedural approach of patients treated with rivaroxaban, with the aim to give practical recommendations to improve patients’ management during and after surgery.
Areas covered: This article is based on a consensus of specialists involved in anticoagulant treatment and in periprocedural setting, including experts in thrombosis, cardiologists, internists, clinical pathologists and anesthesiologists. The authors performed a review of the literature and expressed statements based on the results of the review as well as on personal experience.
Expert opinion: Rivaroxaban is a safe and effective drug that simplifies management of anticoagulation also in patients undergoing invasive procedures. However, periprocedural management could be challenging and physicians must carefully balance the risk of bleeding and the risk of thrombosis.
Declaration of interest
Bayer supported the editing of this paper with an unrestricted medical grant; the pharmaceutical company had no role in analyzing the data or preparing the manuscript. David Imberti has received consulting, lecture and advisory board fees from Bristol Meyers Squibb, Pfizer, Bayer, Boehringer Ingelheim, Daiichi Sankyo, Instrumentation Laboratory Sanofi Aventis Kedrion. A Tripodi has received speaker’s fees from Bayer, Instrumentation Laboratory and Stago. Andrea Fanelli has recieved speaker’s honoraria from Bayer. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
Notes
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