RIVAROXABAN USE IN THE TREATMENT OF PATIENTS WITH DEEP VEIN THROMBOSIS OR PULMONARY EMBOLISM

This article contains information on the possibilities of using rivaroxaban and other non-vitamin K-associated oral anticoagulants (novel oral anticoagulant (NOAC)) in patients with pulmonary embolism (PE) in both acute and later stages of the disease. In 2019, the European Cardiology Society released updated clinical guidelines, which slightly changed the rules of treatment. The rules state that if the anticoagulant therapy is planned to be started with oral drugs, it is recommended to use one of NOACs. The results of the Einstein-PE randomized clinical study proved the efficacy and safety of rivaroxaban in acute pulmonary embolism. In this study, rivaroxaban showed efficacy for prevention cases of repeated pulmonary embolism that was noninferior to the standard therapy. On top of that, the use of rivaroxaban was associated with fewer large bleeding. The recommended regimen for the use of rivaroxaban in acute pulmonary embolism is 15 mg twice daily for 21 days, then 20 mg once daily for at least 3 months. The article outlines issues related to the need to extend anticoagulant treatment beyond the established standard terms (3-6 months) and issues of choosing a drug for extended treatment. Among other NOACs, rivaroxaban has the most comprehensive evidence base for extended treatment after PE, as its efficacy has been proven in several studies. It is important to note that rivaroxaban is the only NOAC, which was superior not only to placebo (in the EINSTEIN-Extension study), but also to the active drug (more precisely, aspirin in the EINSTEIN-CHOICE study) in preventing the development of re-thromboembolism. At the same time, the safety profile of rivaroxaban was comparable with both placebo and aspirin. The possibility to use NOACs in patients with active oncological disease is one of the new positions in modern clinical guidelines for the treatment of PE. As for rivaroxaban, the reason for this was the results of the SELECT-D study, in which rivaroxaban proved to be more efficient in preventing recurrence compared to the standard treatment with dalteparin, having comparable safety indicators in patients with cancer and PE. Thus, the available data from several clinical studies in patients with PE (in the acute and long-term periods) confirm the possibility of active use of rivaroxaban in this clinical situation.