Aspirin Rob Holland Full Therapeutic Anticoagulant
Aspirin Rob Holland Trial Support The

HIT with thrombosis: Typically, 3 to 6 months (ACCP Linkins 2012; ASH Cuker 2018).

Tablet, Oral: Xarelto: 2.5 mg, 10 mg, 15 mg, 20 mg Tablet Therapy Pack, Oral: Xarelto Starter Pack: 15 mg (42s) and 20 mg (9s) (51 ea).

FXa, as part of the prothrombinase complex consisting also of factor Va, calcium ions, factor II and phospholipid, catalyzes the conversion of prothrombin to thrombin.

Thrombin both activates platelets and catalyzes the conversion of fibrinogen to fibrin.

No clinical data are available for patients with severe hepatic impairment.

Coronary artery disease (stable) or peripheral artery disease: Reduction of risk of major cardiovascular (CV) events (CV death, myocardial infarction, and stroke) in patients with coronary artery disease (chronic) or peripheral artery disease.

Aspirin Rob Holland Full Therapeutic Anticoagulant

Indefinite anticoagulation (reduced intensity dosing against venous thromboembolism recurrence): Reduction in the risk of recurrence of deep vein thrombosis (DVT) and pulmonary embolism (PE) in patients at continued risk of DVT and PE following 6 months of initial full therapeutic anticoagulant treatment for DVT andor PE.

Venous thromboembolism (deep vein thrombosis or pulmonary embolism): Treatment of DVT or PE.

Venous thromboembolism prophylaxis in acutely ill medical patients: Prophylaxis of venous thromboembolism (VTE) and VTE-related death during hospitalization and posthospital discharge in adults admitted for an acute medical illness who are at risk for thromboembolic complications due to moderate or severe restricted mobility and other risk factors for VTE and not at high risk of bleeding.

Venous thromboembolism prophylaxis in total hip or knee arthroplasty: Postoperative thromboprophylaxis of DVT, which may lead to PE in patients undergoing total hip arthroplasty or total knee arthroplasty.

Caution should be employed when using rivaroxaban in this setting and should only be used in patients without high risk of bleeding Lip 2020.

Heparin-induced thrombocytopenia (treatment) Data from case series, small prospective cohort studies, and a systematic review suggest that rivaroxaban may be used in the management of patients with heparin-induced thrombocytopenia (HIT) Linkins 2016, Kunk 2017, Sharifi 2015, Shatzel 2016, Warkentin 2017.

Based on the American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia, rivaroxaban is an effective and recommended agent for heparin-induced thrombocytopenia complicated by thrombosis (HITT) or heparin-induced thrombocytopenia without thrombosis (isolated HIT).

Aspirin Rob Holland Trial Support The

Superficial vein thrombosis, acute symptomatic Data from a small phase 3b, open-label, randomized, double-blind trial support the use of rivaroxaban in the treatment of superficial vein thrombosis, particularly if there is involvement of the great saphenous vein, a 5 cm segment is affected, or other risk factors for venous thromboembolism are present Beyer-Westendorf 2017.

Venous thromboembolism prophylaxis, nonmajor orthopedic surgery of lower limb Data from a parallel-group, randomized, double-blind, noninferiority trial support the use of rivaroxaban for venous thromboembolism (VTE) prophylaxis following nonmajor orthopedic surgery of the lower limb in patients at increased risk for developing VTE (eg, history of VTE, immobility, high risk surgery) Samama 2020.

Atrial fibrillation, nonvalvular (to prevent stroke and systemic embolism): Oral: 20 mg once daily with the evening meal.

Postpercutaneous coronary intervention with stent placement and nonvalvular atrial fibrillation (off-label): Oral: 15 mg once daily with food; administer with an appropriate antithrombotic regimen including clopidogrel (preferred P2Y12 inhibitor in this situation) with or without aspirin, depending on risk for thrombosis and bleeding (Gibson 2016; Khan 2020; Sarafoff 2020).

Coronary artery disease: Acute coronary syndrome (after stabilization with initial management) (off-label): Note: As add-on to clopidogrel ( not prasugrel or ticagrelor) and aspirin therapy in patients who are not at high risk of bleeding and do not require chronic therapeutic anticoagulation for another indication; patient preference should also be taken into consideration given the higher risk of bleeding when adding rivaroxaban to dual antiplatelet therapy (Lip 2020).

Oral: 2.5 mg twice daily; administer in combination with low dose aspirin plus clopidogrel; continue rivaroxaban for 1 year (Lip 2020; Mega 2012).

Coronary artery disease (stable) or peripheral artery disease (prevention of major cardiovascular events): Note: May consider use in carefully selected patients who are at high risk of cardiovascular events and low risk of bleeding if therapeutic anticoagulation or dual antiplatelet therapy is not required for another indication (Eikelboom 2017).

Oral: 2.5 mg twice daily; administer in combination with daily low dose aspirin.

Heparin-induced thrombocytopenia (off-label use): Note: For treatment of acute heparin-induced thrombocytopenia (HIT), either as initial therapy in selected hemodynamically stable patients or after initial therapy with a parenteral non-heparin anticoagulant (Kunk 2017; Shatzel 2016; Warkentin 2017).

Note: If initially treated with a parenteral non-heparin anticoagulant, can transition to 20 mg once daily after platelet count recovery.

However, if the parenteral non-heparin anticoagulant is administered for Duration: Not well established: HIT without thrombosis: Typically, 4 weeks to 3 months (ACCP Linkins 2012).

Some experts allow for discontinuation of anticoagulation after platelet count recovery, potentially resulting in a shorter duration (ASH Cuker 2018).