RIVAROXABAN, A DIRECT FACTOR XA INHIBITOR: A DRUG UPDATE

Warfarin, a vitamin K antagonist has been the leading oral anticoagulant since early 1940s despite limitations like slow onset and offset of action, variations in metabolism, multiple food and drug interactions, narrow therapeutic index and need for routine laboratory monitoring. Rivaroxaban, a direct factor Xa inhibitor is a recently introduced orally effective novel anticoagulant offering improvement over current standard of care such as good bioavailability, low propensity for food and drug interactions, rapid onset of action, ease of administration, wide therapeutic index, predictable anticoagulant response and fixed oral dosage, limited side effects and no inter subject variability. Over and above, the drug doesn’t require coagulation monitoring. Thus rivaroxaban has the potential to be an attractive alternative to current anticoagulants, providing effective and well tolerated anticoagulation in a convenient manner in patients with stroke and systemic embolism with non-valvular atrial fibrillation (AF), treatment and prevention of deep vein thrombosis (DVT), pulmonary embolism (PE) etc. Moreover, specific antidotes (Aripazine-PER 977; Ciraparantag) and Andexanet (PR TO64445) antagonising the pharmacodynamic effect of rivaroxaban are under trial.