Rivaroxaban was just FDA approved after it was found to be as good as Coumadin (Warfarin) for stroke prevention in those with atrial fibrillation.
This should come as a relief to those of you on warfarin for atrial fibrillation, deep venous thrombosis (DVT) or a prosthetic valve. The newcomer Rivaroxaban will mean no more INR blood tests for you to monitor levels as you do with Warfarin.
Rivaroxaban (Xarelto) was equivalent to Warfarin for the prevention of stroke or clot in patients with atrial fibrillation. Rivaroxaban was approved by the FDA in July 2011 and is an oral medication used as an anti-clot medication that inhibits factor Xa. It is used now for prevention of deep venous thrombosis in patients after surgery and the use of this medication will likely expand.
Patients with atrial fibrillation and no significant valve disease were given either Warfarin or Rivaroxaban and the results were similar for prevention of stroke or embolism (blood clot to the brain or elsewhere.)
Also exciting is that complications like bleeding were no different with Rivaroxaban compared to Warfarin and in fact brain hemorrhage and fatal bleeding was lower in the Rivaroxaban group compared to Warfarin.
Oral alternatives to Warfarin have arrived. The simplicity of not having to be monitored with an INR check is attractive, and they appear to have an efficacy similar to that of Warfarin.
There are downsides of course: It’s new, expensive, and is not easily reversed (like Warfarin…where you can use Vitamin K.) Rivaroxaban works by inhibiting coagulation factor Xa and is approved for the prevention of deep vein thrombosis, which may lead to pulmonary embolism, in patients undergoing knee or hip replacement surgery.
Insurance doesn’t cover this medication yet and it has not yet been approved for treatment of pulmonary embolism or prevention of clot after valve replacement but it will. When it is, I say cheers to all of you who have been diligent about getting your INR checked every week or so…and may you kiss those days goodbye.
- Dr O.