Vaskulárna medicína 3/2010

Rivaroxaban (XARELTO) – an orally administered anticoagulant for thromboprophylaxis in orthopedic surgery

Thromboprophylaxis in orthopedic surgery is recently realized using low molecular heparins applied parenterally followed by warfarin with the necessity of laboratory monitoring. New orally administered anticoagulants are now available. Substances are of the character so-called „small molecules” being direct inhibitors of coagulation enzymes. Rivaroxaban is direct inhibitor of factor Xa which represents a common product of the external and internal branch of coagulation cascade. Its inhibition slows down catalytic processes in whole cascade reducing thrombin production as following step. There is presented a review of studies of the phase II and III realized in patients after hip- and knee replacement in comparison with enoxaparin. A fixed orally administered rivaroxaban dose 10 mg (one tablet) once daily was derived from the results of studies for wide majority of patients. No adjustment has to be made following body weight, age as well as in case of moderate renal failure. Rivaroxaban was superior to enoxaparin evaluating thromboembolic protection 5 weeks after hip- and 2 weeks after knee replacement. Bleeding as side effect did correspond to frequency after enoxaparine and was rare at all. Conclusion: Rivaroxaban represents an innovative anticoagulant bringing a possibility to provide profylactic treatment with a simple standard 10 mg once daily dose without necessity of laboratory monitoring.

Keywords: anticoagulants, rivaroxaban, thromboprophylaxis, orthopedic surgery