rivaroxaban and Vascular-Diseases

Aspirin resistance describes a phenomenon where patients receiving aspirin therapy do not respond favorably to treatment, and is categorized by continued incidence of adverse cardiovascular events and/or the lack of reduced platelet reactivity. Studies demonstrate that one in four patients with vascular disease are resistant to aspirin therapy, placing them at an almost four-fold increased risk of major adverse limb and adverse cardiovascular events. Despite the increased cardiovascular risk incurred by aspirin resistant patients, strategies to diagnose or overcome this resistance are yet to be clinically validated and integrated. Currently, five unique laboratory assays have shown promise for aspirin resistance testing: Light transmission aggregometry, Platelet Function Analyzer-100, Thromboelastography, Verify Now, and Platelet Works. Newer antiplatelet therapies such as Plavix and Ticagrelor have been tested as an alternative to overcome aspirin resistance (used both in combination with aspirin and alone) but have not proven to be superior to aspirin alone. A recent breakthrough discovery has demonstrated that rivaroxaban, an anticoagulant which functions by inhibiting active Factor X when taken in combination with aspirin, improves outcomes in patients with vascular disease. Current studies are determining how this new regime may benefit those who are considered aspirin resistant.

Topics: Anticoagulants; Aspirin; Clopidogrel; Factor X; Humans; Platelet Aggregation Inhibitors; Point-of-Care Testing; Rivaroxaban; Ticagrelor; Vascular Diseases

Rivaroxaban is a direct inhibitor of activated coagulation factor X and competitively targets factor Xa via reversible binding. We conducted a systematic review of the efficacy and safety of rivaroxaban for treatment of livedoid vasculopathy (LV) by searching the PubMed, Cochrane and Embase databases. A total of 22 articles and 1 registered clinical trial were identified in the search of which 13 were included. The studies included 73 LV patients receiving rivaroxaban therapy (10-20 mg per day). Overall, 60 patients (82.2%) had responses to therapy, achieving remission of both pain and ulceration. Few adverse effects were observed. Thus, the consensus of the clinical evidence is that rivaroxaban is a well-tolerated and effective treatment for LV. However, this still needs to be confirmed by large prospective and/or case control studies.

Topics: Case-Control Studies; Humans; Prospective Studies; Rivaroxaban; Treatment Outcome; Vascular Diseases

Topics: Aspirin; Atherosclerosis; Double-Blind Method; Drug Therapy, Combination; Factor Xa Inhibitors; Fibrinolytic Agents; Follow-Up Studies; Humans; Rivaroxaban; Treatment Outcome; Vascular Diseases

We investigated the impact of polyvascular disease in patients enrolled in ROCKET AF.. Cox regression models were used to assess clinical outcomes and treatment effects of rivaroxaban compared with warfarin in patients with atrial fibrillation and coronary, peripheral, or carotid artery disease, or any combination of the 3.. A total of 655 (4.6%) patients had polyvascular disease (≥2 disease locations), and 3,391 (23.8%) had single-arterial bed disease. Patients with polyvascular disease had similar rates of stroke/systemic embolism but higher rates of cardiovascular and bleeding events when compared with those without vascular disease. Use of rivaroxaban compared with warfarin was associated with higher rates of stroke in patients with polyvascular disease (hazard ratio [HR] 2.41, 95% CI 1.05-5.54); however, this was not seen in patients with single-bed (HR 0.90, 95% CI 0.64-1.28) or no vascular disease (HR 0.85, 95% CI 0.69-1.04; interaction P = .058). There was a significant interaction for major or nonmajor clinically relevant bleeding in patients with polyvascular (HR 1.23, 95% CI 0.91-1.65) and single-bed vascular disease (HR 1.30, 95% CI 1.13-1.49) treated with rivaroxaban compared with warfarin when compared with those without vascular disease (HR 0.95, 95% CI 0.87-1.04; interaction P = .0006). Additional antiplatelet therapy in this population did not improve stroke or cardiovascular outcomes.. The use of rivaroxaban compared with warfarin was associated with a higher risk of stroke and bleeding in patients with polyvascular disease enrolled in ROCKET AF. Further studies are needed to understand the optimal management of this high-risk population.

Topics: Aged; Anticoagulants; Atrial Fibrillation; Double-Blind Method; Female; Hemorrhage; Humans; Male; Outcome Assessment, Health Care; Risk Assessment; Risk Factors; Rivaroxaban; Severity of Illness Index; Stroke; Vascular Diseases; Warfarin

Topics: Aspirin; Factor Xa Inhibitors; Humans; Platelet Aggregation Inhibitors; Rivaroxaban; Vascular Diseases

Topics: Aspirin; Factor Xa Inhibitors; Humans; Platelet Aggregation Inhibitors; Rivaroxaban; Vascular Diseases

The evaluation and application of antithrombotic strategies able to reduce total and cardiovascular mortality in patients with documented vascular disease have an important clinical and epidemiological role and may also impact on health costs. In the COMPASS trial, the association of rivaroxaban at the dose of 2.5 mg twice daily with aspirin in a population with stable vascular disease has significantly reduced the incidence of cardiovascular events compared to the standard regimen of aspirin alone; this reduction translated into greater cardiovascular and total survival. Such mortality benefit was not observed in previous randomized trials that in this setting of patients had previously evaluated antiplatelet strategies alternative to aspirin (with clopidogrel) or had compared a dual antiplatelet therapy with aspirin plus clopidogrel, vorapaxar, or ticagrelor vs a single antiplatelet treatment with aspirin. The results of the COMPASS trial strengthen the role of antithrombotic strategies that, beside the platelet phase, also involve the coagulative phase with the aim at preventing the recurrence of cardiovascular, atherothrombotic events at the site of polyvascular beds, with a degree of benefit proportional to the baseline risk of the patient.

Topics: Anticoagulants; Aspirin; Drug Therapy, Combination; Humans; Platelet Aggregation Inhibitors; Randomized Controlled Trials as Topic; Rivaroxaban; Vascular Diseases

The authors analysed oral anticoagulant agents prescribed in the postoperative period to patients after endured reconstructive operative intervention on arteries of the femorotibial segment. The study included a total of 104 patients subjected to femoropopliteal or femorotibial bypass grafting using an autologous vein or a prosthesis. Depending on the prescribed anticoagulation agent, the patients were subdivided into two groups. Group One patients (n=43) in the postoperative period received rivaroxaban, and Group Two patients (n=61) took warfarin. Efficacy of therapy was evaluated by the frequency of haemorrhage and thromboses in the early and remote postoperative periods. The findings of the immediate postoperative period demonstrated comparable rates of haemorrhagic complications, early thromboses and redo interventions in both Groups (p=0.7). The duration of long-term postoperative period varied from 3 months to 5 years. No statistically significant differences in patency of the performed reconstructions were revealed between the groups. The 3-year primary assisted patency rate in the rivaroxaban group and warfarin group amounted to 89 and 80%, respectively. The incidence of haemorrhagic complications in the postoperative period was insignificant in the studied groups. Hence, rivaroxaban may be prescribed in the early and remote postoperative period to patients who underwent open reconstructive operative intervention on arteries of the infrainguinal zone.. Проведен анализ оральных антикоагулянтных препаратов, назначенных в послеоперационном периоде больным, которым осуществлено реконструктивное оперативное вмешательство на артериях бедренно-берцового сегмента. В исследование включено 104 пациента, каждому из них проводилось бедренно-подколенное или бедренно-берцовое шунтирование с использованием аутовены или протеза. В зависимости от назначаемого антикоагулянтного препарата больные были разделены на две группы. Пациенты 1 группы (n=43) в послеоперационном периоде получали ривароксабан, пациенты 2 группы (n=61) - варфарин. Эффективность терапии оценивалась по частоте развития кровотечений и тромбозов в раннем и отдаленном послеоперационном периодах. В ближайшем послеоперационном периоде отмечен сопоставимый уровень геморрагических осложнений, ранних тромбозов и повторных вмешательств в двух группах (р=0,7). Срок наблюдения в отдаленном послеоперационном периоде составил от 3 месяцев до 5 лет. Статистически значимой разницы в проходимости выполненных реконструкций между группами не выявлено. Первичная ассистированная проходимость через 3 года в группе ривароксабана достигала 89%, в группе варфарина - 80%. Частота развития геморрагических осложнений в послеоперационном периоде была незначимой в исследуемых группах. Таким образом, ривароксабан может быть назначен в раннем и отдаленном послеоперационном периоде пациентам, которым проведено открытое реконструктивное оперативное вмешательство на артериях инфраингвинальной зоны.

Topics: Anticoagulants; Arteries; Blood Vessel Prosthesis Implantation; Femoral Artery; Humans; Lower Extremity; Popliteal Artery; Retrospective Studies; Rivaroxaban; Tibial Arteries; Treatment Outcome; Vascular Diseases; Vascular Patency; Warfarin

Topics: Aspirin; Atherosclerosis; Chronic Disease; Clinical Trials as Topic; Death; Drug Therapy, Combination; Factor Xa Inhibitors; Fibrinolytic Agents; Hemorrhage; Humans; Myocardial Infarction; Platelet Aggregation Inhibitors; Rivaroxaban; Secondary Prevention; Stroke; Thrombosis; Vascular Diseases

Topics: Aspirin; Factor Xa Inhibitors; Humans; Kidney Diseases; Rivaroxaban; Vascular Diseases

Activation of coagulation and vascular inflammation are prominent features of sickle cell disease (SCD). Previously, we have shown that inhibition of tissue factor (TF) attenuates activation of coagulation and vascular inflammation in mouse models of SCD. In this study, we examined the mechanism by which coagulation proteases enhance vascular inflammation in sickle BERK mice. To specifically investigate the contribution of FXa and thrombin, mice were fed chow containing either rivaroxaban or dabigatran, respectively. In addition, we used bone marrow transplantation to generate sickle mice deficient in either protease activated receptor-1 (PAR-1) or protease activated receptor-2 (PAR-2) on nonhematopoietic cells. FXa inhibition and PAR-2 deficiency in nonhematopoietic cells attenuated systemic inflammation, measured by plasma levels of interleukin-6 (IL-6). In contrast, neither thrombin inhibition nor PAR-1 deficiency in nonhematopoietic cells affected plasma levels of IL-6 in sickle mice. However, thrombin did contribute to neutrophil infiltration in the lung, independently of PAR-1 expressed by nonhematopoietic cells. Furthermore, the TF-dependent increase in plasma levels of soluble vascular cell adhesion molecule-1 in sickle mice was not mediated by FXa or thrombin. Our data indicate that TF, FXa, and thrombin differentially contribute to vascular inflammation in a mouse model of SCD.

Topics: Anemia, Sickle Cell; Animals; Anticoagulants; Antithrombins; Benzimidazoles; beta-Alanine; Bone Marrow Transplantation; Dabigatran; Disease Models, Animal; Factor Xa; Factor Xa Inhibitors; Female; Immunoenzyme Techniques; Inflammation; Male; Mice; Mice, Inbred C57BL; Mice, Knockout; Morpholines; Receptor, PAR-1; Receptor, PAR-2; Rivaroxaban; Thiophenes; Thrombin; Vascular Diseases