rivaroxaban: quick review

8 Nov

Nice review of rivaroxaban in September’s Emergency Medicine News by Dr. Rob Orman.

Click through for the article, worth a read.  Some highlights below:

QUICK HITS:

rivaroXaban (a.k.a. Xarelto) = factor Xa inhibitor

emerging popular DVT treatment

studies had similar efficacy and major bleed rates (vs. LMWH + warfarin), but study was imperfect (INR therapeutic 50-60% time in the study)

half-life 5-9 hrs

cannot be dialyzed, 95% protein bound

REVERSAL? (a.k.a. what we often care about with these newer anticoagulants)

maybe with prothrombin complex concentrate (PCC). maybe.

(PCC = factors II, VII, IX, X)

rabbit study: PCC fixed the PT, but ears bled just as long

rat mesenteric bleed study: PCC at 50 units/kg normalized bleeding time, 25 units/kg did nothing

BOTTOM LINE:

“So, some animal data say PCC has little effect on bleeding, and other evidence says PCC reverses bleeding. But a rat’s gut is not a human’s brain.

Can we infer that [this] applies to the catastrophic brain bleed you are seeing in your resuscitation bay? Maybe, but it’s still unknown.”

References: EMN article; coag cascade pic

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