Dosing of rivaroxaban by indication: getting the right dose for the patient

Abstract

Introduction: 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.

Areas covered: 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.

Expert opinion: 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.

Keywords:

• anticoagulants
• pharmacodynamics
• pharmacokinetics
• rivaroxaban
• thrombosis

Declaration of interest

G Escolar has received honoraria fees from Bayer, Bristol-Myers Squibb, Boehringer Ingelheim, CSL Behring, and Novo Nordisk. 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. Editorial support from Abigail Macleod was utilized in the production of this manuscript and was funded by Bayer HealthCare Pharmaceuticals and Janssen Research and Development, LLC.

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