Abstract
Direct oral anticoagulants (DOACs) are widely used for the prevention of stroke in nonvalvular atrial fibrillation, treatment of deep venous thrombosis and pulmonary embolism, and as prophylaxis after hip and knee surgery after approval by the Food and Drug Administration. In the last decade, DOACs were studied for various indications; this review is focused on rivaroxaban, a factor Xa inhibitor, which is used in an expanded evidence-based fashion for coronary artery disease, peripheral artery disease, heart failure, malignancy, and prophylaxis of deep venous thrombosis in acute medical illnesses.
Highlights
Vitamin K antagonists (VKAs) have been used for anticoagulation in humans since 1954 and were even prescribed to sitting President Dwight Eisenhower after his myocardial infarction
Rivaroxaban is a small molecule that reversibly inhibits both free and clot-bound factor Xa [2]. It has been used until recently mostly for nonvalvular atrial fibrillation (NVAF) and deep venous thrombosis or venous embolism, but its use is increasing in a growing variety of vascular conditions, notably coronary artery disease, peripheral artery disease, and thromboprophylaxis
The systematic review and network meta-analysis comparing the direct oral anticoagulants found that all Direct oral anticoagulants (DOACs) are effective in reducing the risk of venous thromboembolism and preventing death related to venous thromboembolism, the bleeding profile of apixaban was better compared to other DOACs [23]
Summary
Vitamin K antagonists (VKAs) have been used for anticoagulation in humans since 1954 and were even prescribed to sitting President Dwight Eisenhower after his myocardial infarction. Due to various limitations of VKA (e.g., drug-drug interactions, narrow therapeutic window, and need for a blood test to monitor therapeutic effect), DOACs which affect specific targets factor Xa and/or factor II have emerged as a potentially preferred therapeutic strategy to overcome these limitations [1]. Rivaroxaban is a small molecule that reversibly inhibits both free and clot-bound factor Xa [2]. It has been used until recently mostly for nonvalvular atrial fibrillation (NVAF) and deep venous thrombosis or venous embolism, but its use is increasing in a growing variety of vascular conditions, notably coronary artery disease, peripheral artery disease, and thromboprophylaxis. The purpose of this review is to provide a comprehensive overview of rivaroxaban use for these rapidly broadening indications
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