A study on the role of rivaroxaban in management of venous thromboembolism

BackgroundOver 50 years the research work all over the world was concerning to find out a novel oral heparin to avoid the side effects of conventional anticoagulants as warfarin which requires changes in diet and lifestyle, regular checkup, and has a risk of severe hemorrhage. Rivaroxaban offers such advantages as oral mode of administration, more predictable anticoagulant response, greater specificity with no need for routine checkup and patient monitoring and has a uniform dose. When switching patients from warfarin to rivaroxaban, warfarin is discontinued and rivaroxaban is started as soon as INR is below 3.0 to avoid periods of inadequate anticoagulation.Aim of the workTo study the role and suitability of oral rivaroxaban therapy in management of venous thromboembolism in Egyptian patients.Patient and methodsThis work was done over 120 mild or minor pulmonary embolism patients, divided into 2 groups, group I included 100 patients received oral rivaroxaban for 1 week, continued with warfarin for 6 months guided with INR measurement, group II included 20 patients who are financially supported and can continue with rivaroxaban for 6 months. The following was done for all patients. Clotting time (CT), D Dimer, INR, APTT, platelet count, complete liver and kidney functions, digital X ray Chest, multi-slice CT angiogram in some cases, and ECG, CK MB and troponin when needed.ResultsOur patients were divided into 2 groups, group I included 100 patients 54 males and 46 females with a mean age of 48.3 ± 15.43 and a mean body weight of 84.7 ± 16.4 group II included 20 patients 11 males and 9 females with a mean age of 45.6 ± 12.21and a mean body weight of 85.2 ± 12, the recorded side effects were minor bleeding in 11% of the cases of group I and 10% of the cases of group II, headache in 6% of the cases of group I and 5% of the cases of group II, GIT upset in 5% of the cases in both groups, dizziness in 4% of the cases of group I and 5% of the cases of group II with no statistical significant differences between the 2 arms of the study.Conclusion and recommendationRivaroxaban is a rapid onset of anticoagulant that can be given in fixed doses without routine monitoring. It can replace injectable anticoagulants as an initial treatment in management of patients with mild venous thromboembolism as it is suitable as regard the economic and the health status of the Egyptian patients.