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Rivaroxaban Not Suitable for Extended Prophylactic Anticoagulation

By jeremyc | February 25, 2013

A recent study published in the New England Journal of Medicine says that the benefits of Rivaroxaban for extended prophylactic anticoagulation are outweighed by the risk of bleeding. As a result, it is still uncertain if extended prophylactic anticoagulation may be beneficial for such patients. A recent trial regarding apixaban, a next-generation anticoagulant, also showed an increased risk of bleeding. Another recent study that compared enoxaparin, which is the current standard for treatment, with a placebo and saw that extended prophylaxis may be beneficial only for some subgroups.

This controlled trial established that a daily dose of 10mg Rivaroxaban is not inferior to a subcutaneous injection of 40mg enoxaparin per day for the prevention of thromboembolism during standard treatment. Nevertheless, Rivaroxaban also comes with an increased risk of bleeding. The study had 8,101 patients who either received enoxaparin or a placebo along with Rivaroxaban or an oral placebo for a period of 10 days. In the end of these 10 days, it was found that 2.7 percent of patients in each group had either a symptomatic venous or an asymptomatic proximal thromboembolism.

After this, the patients were given oral treatment for 25 more days, but the end of which the rates had gone up to 4.4 percent in the group who took Rivaroxaban and 5.7 percent in the group who took enoxaparin. This means a 23 percent reduction in risk when taking Rivaroxaban, as per Alexander Cohen, the head researcher of the study from King’s College Hospital, London.

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