Xarelto ~ A Novel Oral Anticoagulant
~ Dr. Jihua Cheng
Xarelto (rivaroxaban) is an FDA-approved novel oral anticoagulant (“blood thinner”) to treat and prevent deep vein thrombosis (DVT), pulmonary embolism (PE); and to prevent stroke and systemic embolism in patients with non-valvular atrial fibrillation.
Blood clots occur when blood flow stops and clumps together. Deep vein thrombosis (DVT) is a blood clot that forms in a vein deep in the body, often in the lower leg or thigh. The blood clot can break off and travels to the lungs following blood flow and it can lead to a potentially fatal condition called pulmonary embolism (PE).
Xarelto is initially FDA-approved in July 2011 to reduce the risk of DVTs and PEs in patients undergoing knee or hip replacement surgery. It was then approved in November 2011 to reduce the risk of stroke in people who have a type of abnormal heart rhythm called non-valvular atrial fibrillation.
Other drugs approved by FDA to treat or reduce the risk of blood clots include Lovenox (enoxaparin), Arixtra (fondaparinux), Fragmin (dalteparin), and heparin – these have to be given by either subcutaneous injection or intravenous injection. Currently Coumadin (warfarin) and Xarelto (rivaroxaban) are the only two oral anticoagulants that were FDA-approved in this condition. Other NOAs, such as Dabigatran (Pradaxa); Apixaban (Eliquis) were approved only for patients with non-valvular atrial fibrillation.
There are several reported advantages of NOAs as comparing to warfarin: they are rapid onset, fixed dosing, no interactions with food and only few interactions with drugs, no need for frequent blood monitoring, and if patient need to go for surgery, the offset is shorter.
Importantly, there are also several disadvantages of NOAs that patients need to be aware: There is currently no approved specific antidote or established protocol for reversal. Second, the out of pocket expenses is often high. Thirdly, unlike warfarin, NOAs are mainly eliminated through kidney (25-80%); the risk of bleeding increases in patient with kidney insufficiency. And due to its short half-life, there is a concern for increased risk of systemic embolism or risk of stroke with poor drug adherence or discontinuation (Black Box warning in atrial fibrillation).
We at Andrews and Patel Associates are very experienced with these novel oral anticoagulants (NOAs) for our patients with deep vein thrombosis (DVT), pulmonary embolism (PE); and the management of anticoagulation (“blood thinner”) before, during and after surgery. We are committed to providing the best possible, quality, compassionate care for each and every of our patients.