Rivaroxaban in der Prävention und Therapie thromboembolischer Erkrankungen

Summary

Rivaroxaban (Xarelto^®) is a new anticoagulant for the prevention and treatment of thromboembolic disorders. Rivaroxaban inhibits coagulation factor Xa directly, has high oral bioavailability, shows low propensity for drug-drug interactions and requires no routine coagulation monitoring. In patients undergoing elective knee or hip replacement surgery rivaroxaban (10 mg/d) is highly effective to prevent venous thromboembolism. In patients with non-valvular atrial fibrillation rivaroxaban (20 mg/d) has been approved to prevent stroke or systemic embolism. The favourable benefit-risk profile of rivaroxaban in the treatment of deep vein thrombosis (DVT) was shown in EINSTEIN-DVT and led to its clinical approval (twice daily 15 mg for 3 weeks, followed by 20mg/d). Based on ATLASACS-TIMI-51 which has shown that rivaroxaban (2.5 mg twice daily) reduced thrombotic cardiovascular events and mortality in patients with a recent acute coronary syndrome, the approval of low dose rivaroxaban has been submitted for this indication.

Taken together, rivaroxaban may become an effective alternative to standard anticoagulants in the prevention and treatment of thromboembolic disorders.

Zusammenfassung

Rivaroxaban (Xarelto^®) ist ein neues Antikoagulans zur Prävention und Therapie thromboembolischer Erkrankungen. Es hemmt direkt den Faktor Xa, ist oral bioverfügbar, zeigt geringe Medikamenten-Interaktionen und erfordert keine routinemäßigen Gerinnungskontrollen. Zur Prävention venöser Thromboembolien kann Rivaroxaban (10 mg 1×/d) bei Patienten nach elektivem Knieoder Hüftgelenkersatz eingesetzt werden. Rivaroxaban (20 mg 1×/d) wurde aufgrund der Daten aus ROCKET-AF zur Prävention von Schlaganfällen und systemischen Embolien bei Patienten mit nicht-valvulärem Vorhofflimmern zugelassen. Das günstige Nutzen-Risiko-Profil von Rivaroxaban bei der Therapie der tiefen Beinvenenthrombose wurde in EINSTEIN-DVT gezeigt und führte zur Zulassung auch für diese Indikation (15 mg 2×/d für 3 Wochen, dann 20 mg 1×/d). Aufgrund der ATLAS-ACS-TIMI-51-Daten, nach denen Rivaroxaban in einer Dosis von 2,5 mg 2×/d nach akutem Koronarsyndrom (ACS) kardiovaskuläre (thrombotische) Ereignisse und die Mortalität reduziert, wurde die Zulassung für die Sekundärprophylaxe des ACS mit Rivaroxaban beantragt.

Zusammenfassend dürfte Rivaroxaban eine neue Alternative zu den bisherigen Standardantikoagulanzien in der Prävention und Behandlung thromboembolischer Erkrankungen darstellen.

Keywords

New anticoagulants - rivaroxaban - factor X

Schlüsselwörter

Neue Antikoagulanzien - Rivaroxaban - Faktor X

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