scholarly journals Update on Rivaroxaban

2010 ◽  
Vol 3 ◽  
pp. CMBD.S5101
Author(s):  
Osama Moussa ◽  
Dipankar Chattopadhyay ◽  
Vish Bhattacharya
Keyword(s):  
Clinical Trials ◽  
Venous Thromboembolism ◽  
Dose Adjustment ◽  
Coagulation Cascade ◽  
Regular Monitoring ◽  
New Anticoagulants ◽  
Frequent Dose ◽  
Prevention And Treatment ◽  
Advanced Stages ◽  
Specific Factors

Anticoagulants are recommended for the prevention and treatment of venous thromboembolism (VTE). The new anticoagulants which target specific factors in the coagulation cascade offer the advantage that they can be administered orally. These drugs seek to offer safe anticoagulation without the need for regular monitoring and frequent dose adjustment. Some of these newer drugs are in the advanced stages of clinical trials or have already completed them and thereby aim to provide more options in the management of thromboembolism. In the present review we discuss the currently available evidence supporting the use of these new anticoagulants, in particular rivaroxaban.

Consultations on Patients with Venous or Arterial Diseases

Hematology ◽  
2003 ◽  
Vol 2003 (1) ◽  
pp. 540-558 ◽  
Author(s):  
Barbara M. Alving ◽  
Charles W. Francis ◽  
William R. Hiatt ◽  
Mark R. Jackson
Keyword(s):  
Clinical Trials ◽  
Arterial Thrombosis ◽  
Interventional Procedures ◽  
Arterial Disease ◽  
Vascular Medicine ◽  
Optimal Care ◽  
Vascular Surgeon ◽  
New Anticoagulants ◽  
Prevention And Treatment ◽  
Peripheral Arterial

Abstract Advances in vascular biology and drug development, as well as improved interventional techniques, are yielding multiple new treatments for patients with venous and/or arterial thrombosis. Hematologists who are providing consultations for these patients often participate in a multidisciplinary approach to provide optimal care. New anticoagulants, simplified and validated tests for detecting vascular disease, and improved interventional procedures can all reduce the morbidity and mortality that result from venous and arterial thrombosis. In this chapter, different aspects of the diagnosis and treatment of these disorders are addressed by a hematologist, an expert in vascular medicine, and a vascular surgeon. The key to the prevention and treatment of venous and arterial thrombosis is anticoagulant and antiplatelet therapy. In Section I, Dr. Charles Francis, a hematologist with expertise in thrombosis and hemostasis, describes the clinical trials that have resulted in the approval of newer anticoagulants such as fondaparinux and the thrombin- specific inhibitors. He also reviews the clinical trials that have shown the efficacy of the new oral anticoagulant ximelagatran. Although currently under study primarily for the prevention and treatment of venous thrombosis, these anticoagulants are likely to undergo evaluation for use in arterial thrombosis. Peripheral arterial disease (PAD), which affects as many as 12% of individuals over the age of 65 years, provides a diagnostic and therapeutic challenge to physicians across multiple subspecialties. Dr. William Hiatt, a specialist in vascular medicine, discusses in Section II the epidemiology and manifestations of PAD, the best ways in which to diagnose this disorder and determine its severity, and the most appropriate pharmacologic treatment. In Section III, Dr. Mark Jackson, a vascular surgeon, describes interventional procedures that have been developed or are under development to treat arterial thrombosis. He also reviews the status of inferior vena caval filters that are retrievable.

scholarly journals Potential role of new anticoagulants for prevention and treatment of venous thromboembolism in cancer patients

2013 ◽  
pp. 207 ◽  
Author(s):  
Antonio Gómez-Outes ◽  
Suárez-Gea ◽  
Lecumberri ◽  
Ana Isabel Terleira-Fernández ◽  
Emilio Vargas-Castrillón ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Potential Role ◽  
New Anticoagulants ◽  
Prevention And Treatment

Venous and arterial thrombosis – pathogenesis and the rationale for anticoagulation

2011 ◽  
Vol 105 (04) ◽  
pp. 586-596 ◽  
Author(s):  
Charles Esmon ◽  
Alexander Turpie
Keyword(s):  
Arterial Thrombosis ◽  
Anticoagulation Therapy ◽  
Factor Xa ◽  
Clinical Development ◽  
Coagulation Cascade ◽  
Coagulation Activation ◽  
Oral Agents ◽  
Prevention And Treatment ◽  
Advanced Stages ◽  
Scientific Rationale

SummaryThromboembolic disorders are major causes of morbidity and mortality. It is well-recognised that the pathogenesis is different for arterial and venous thrombosis; however, both involve coagulation activation. Anticoagulants are used for the prevention and treatment of a wide variety of thromboembolic and related conditions. Agents with anti-inflammatory properties in addition to anticoagulation may be particularly beneficial. Traditional anticoagulants, although effective, are associated with certain limitations. Understanding the pathological processes associated with thrombosis and the rational target for anticoagulation is essential, not only for the development of safer and more effective agents, but also for better clinical management of patients who require anticoagulation therapy. In recent years, new oral agents that target single enzymes of the coagulation cascade have been developed – some of those are in advanced stages of clinical development. Based on scientific rationale, both factor Xa and thrombin are viable targets for effective anticoagulation.

scholarly journals New anticoagulants in the prevention and treatment of venous thromboembolism

2011 ◽  
Vol 152 (25) ◽  
pp. 983-992 ◽  
Author(s):  
Mátyás Keltai ◽  
Katalin Keltai
Keyword(s):  
Venous Thromboembolism ◽  
Treatment Options ◽  
Factor Xa ◽  
Bleeding Risk ◽  
Current Treatment ◽  
Thrombin Inhibitors ◽  
Major Surgery ◽  
Direct Thrombin Inhibitors ◽  
New Anticoagulants ◽  
Prevention And Treatment

Clinical data on the risk factors, incidence, consequences and current treatment options of venous thromboembolism are reviewed. Current guidelines advise anticoagulant treatment for a few weeks or months in immobilized patients treated in hospital, and after major surgery. The initial treatment is based on heparin, followed by vitamin K antagonist treatment. Recently a number of new, partially orally administered medications have undergone clinical investigations and based on the results three of them were also registered for the prevention and treatment of venous thromboembolism. Direct thrombin inhibitors, direct and indirect Factor Xa inhibitors exhibited proven non-inferiority or superiority compared with traditional treatment options. The superior efficacy or non-inferiority was not accompanied with an increase in the bleeding risk. Results of the most important clinical trials are reviewed. Based on these results, prevention and treatment of venous thromboembolism will change substantially in the next future. Orv. Hetil., 2011, 152, 983–992.

Treatment and secondary prevention of venous thromboembolism in cancer patients

2012 ◽  
Vol 03 (03) ◽  
pp. 121-125
Author(s):  
I. Pabinger ◽  
C. Ay
Keyword(s):  
Clinical Trials ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Oral Anticoagulants ◽  
Factor Xa ◽  
New Oral Anticoagulants ◽  
Phase Iii ◽  
Patients With Cancer ◽  
Potential Use

SummaryCancer is a major and independent risk factor of venous thromboembolism (VTE). In clinical practice, a high number of VTE events occurs in patients with cancer, and treatment of cancerassociated VTE differs in several aspects from treatment of VTE in the general population. However, treatment in cancer patients remains a major challenge, as the risk of recurrence of VTE as well as the risk of major bleeding during anticoagulation is substantially higher in patients with cancer than in those without cancer. In several clinical trials, different anticoagulants and regimens have been investigated for treatment of acute VTE and secondary prophylaxis in cancer patients to prevent recurrence. Based on the results of these trials, anticoagulant therapy with low-molecular-weight heparins (LMWH) has become the treatment of choice in cancer patients with acute VTE in the initial period and for extended and long-term anticoagulation for 3-6 months. New oral anticoagulants directly inhibiting thrombin or factor Xa, have been developed in the past decade and studied in large phase III clinical trials. Results from currently completed trials are promising and indicate their potential use for treatment of VTE. However, the role of the new oral thrombin and factor Xa inhibitors for VTE treatment in cancer patients still has to be clarified in further studies specifically focusing on cancer-associated VTE. This brief review will summarize the current strategies of initial and long-term VTE treatment in patients with cancer and discuss the potential use of the new oral anticoagulants.

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