Characteristics and practical use of rivaroxaban in atrial fibrillation and venous thromboembolism

Rivaroxaban is a new oral direct factor Xa inhibitor recently approved for the treatment of venous thromboembolism (VTE) and for the prevention of stroke in nonvalvular atrial fibrillation (AF). Using a modified Delphi method, a group of Italian multidisciplinary specialists (internists, hematologists, angiologists, cardiologists, neurologists) guided by an expert panel reviewed the practical management of these clinical conditions in different healthcare settings and debated the limitations and gaps in clinical studies, national guidelines and the role of rivaroxaban in VTE and nonvalvular AF. This survey, named "EXTRA project", was divided into two arms (EXTRA-VTE, EXTRA-AF) and took place in two phases: the first was based on a questionnaire filled out on-line, and the second was a meeting attended by all the specialists to address the most controversial topics. Almost all of the participants expressed agreement in considering rivaroxaban a new cornerstone of stroke prevention and treatment of VTE. They appreciated its predictable pharmacokinetics and pharmacodynamics, the wide therapeutic window, the lack of relevant interactions with many commonly prescribed comedications, no requirement for routine coagulation monitoring or dose adjustment, and the good tolerability in a broad spectrum of patients at high risk of complications. The results are here reported and discussed together with the therapeutic contextualization and the future clinical perspectives of rivaroxaban. © 2014 Il Pensiero Scientifico Editore.