Sunday, May 13, 2012

Rivaroxaban management guideline posted on ClotConnect

A guideline we developed for the practical management of rivaroxaban at our institution (click here for the PDF) was recently posted on ClotConnect, an educational website for patients and health care providers developed by the Hemophilia and Thrombosis Center at the University of North Carolina at Chapel Hill.  Rivaroxaban is an oral factor Xa inhibitor indicated for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation as well as for the prevention of venous thromboembolism following orthopedic surgery.  In the guideline, we provide recommendations on the following:
  • Considerations for initiation of therapy (dosing and administration, monitoring parameters, cost considerations)
  • Conversions to and from other anticoagulants, including unfractionated heparin, low molecular weight heparin, fondaparinux, dabigatran, and warfarin
  • Perioperative management
  • Management of hemorrhagic events
  • Patient education
I should disclose that many of the recommendations included in this document have been extrapolated from pharmacokinetic and pre-clinical investigations, as there is little other evidence in the literature to help guide clinicians in the practical management of rivaroxaban.  As such, the content is subject to evolve significantly as we gain more experience with it and the other new oral anticoagulants.  In the meantime, we hope this resource will be useful in assisting other institutions and individual providers who are already using rivaroxaban in clinical practice. 

Special thanks goes to all the other collaborators on this project, including Melissa Hunter and Stacy Miller, who were final year student pharmacists at the time of its creation; Abbie Miller, PharmD, BCPS; and Stephan Moll, MD.

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