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Rivaroxaban an ‘effective and safe’ alternative to warfarin for treating DVT

By Lilian Anekwe

A new anticoagulant could provide an alternative to warfarin in the treatment of patients with deep vein thrombosis (DVT), a study has shown.

Few new anticoagulants have become available since the discovery of warfarin 55 years ago, but several new treatments are approaching a launch in the UK.

A randomised controlled trial presented at the European Society of Cardiology congress found rivaroxaban, an oral once-daily Factor Xa inhibitor, reduced the incidence of thromboembolism with no increase in major bleeds.

More than 3,400 patients with acute symptomatic DVT, but without and symptoms of pulmonary embolism, were randomised to either rivaroxaban 15mg twice daily followed by 20mg once daily, or low molecular weight heparin followed by a vitamin K agonist, and treated to an INR range of between 2.0 and 3.0.

Patients in the rivaroxaban group had a significantly lower incidence of symptomatic recurrent DVT and non-fatal pulmonary embolism, which occurred in 2.1% of the group compared with 3% of the group given standard treatment. 8.1% of both groups experienced a bleeding event.

Lead researcher Professor Harry Büller, professor of vascular medicine at the Academic Medical Center in Amsterdam, concluded: ‘The results indicate that rivaroxaban is an effective and safe treatment for acute symptomatic DVT.

‘The single-drug approach with rivaroxaban will provide clinicians and patients with an attractive, simple, alternative regimen for the initial and long-term treatment of deep vein thrombosis.'

Dr Kathryn Griffith, a cardiology GPSI in York, said: ‘DVT is a big issue in general practice and its management has changed to more of an outpatient basis, so the field has opened up. There are many new anticoagulants coming along, both for DVT and atrial fibrillation.'

‘A once daily drug that you can give patients without having to do a blood test is a big positive. But blood testing does have its advantages - because you can know how effective individual treatments are it does give you an opportunity to manage compliance.'

European Society of Cardiology congress, presented 31 August 2010

Newer drugs could provide an alternative to warfarin