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Author(s): Mehta Hiren R | Patel Paresh B | Galani Varsha J

Journal: International Research Journal of Pharmacy
ISSN 2230-8407

Volume: 2;
Issue: 8;
Start page: 16;
Date: 2011;
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Keywords: Direct factor Xa inhibitor | oral anticoagulant | thrombin generation | rivaroxaban.

Venous thrombo embolism (VTE), which includes deep vein thrombosis and pulmonary embolism, is a major cause of morbidity and mortality in patients undergoing major orthopaedic surgery, and routine thrombo prophylaxis has been the standard of care over the last 20 years. Currently available options for the prevention of venous thrombo embolism in major orthopedic surgery include low-molecular-weight heparins, vitamin K antagonists and, more recently, the synthetic pentasaccharide fondaparinux. Although effective, these drugs have several limitations, and new oral antithrombotics offering predictable, effective and safe anticoagulation are strongly needed. This overview focuses on the most advanced oral direct inhibitors of factor Xa, rivaroxaban.Rivaroxaban, an oral oxazolidinone-based anticoagulant, is a potent, selective direct inhibitor of factor Xa that is used in the prevention of venous thrombo embolism in adult patients after total hip replacement (THR) or total knee replacement (TKR) surgery. In four large, clinical trials, oral rivaroxaban was more effective than subcutaneous enoxaparin in preventing postoperative VTE in patients undergoing total hip replacement or total knee replacement surgery. Notably, the superior efficacy of rivaroxaban was achieved with a low but not significant increase in the incidence of major bleeding episodes. In addition, preliminary pharma co-economic analyses in several countries indicate that rivaroxaban is a cost-effective treatment strategy versus enoxaparin. Although the position of rivaroxaban relative to other therapies remains to be fully determined, it is an effective emerging option for the prevention of venous thrombo embolism following total hip replacement and total knee replacement.
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