Replacing coumadin for DVT treatment?

 

Oral rivaroxaban has been shown to be safe and effective in VTE prophylaxis in orthopedic patients (abstract) (abstract). This phase II study gives us enthusiasm for its safety and efficacy in DVT treatment as well (abstract). 543 participants were randomized to oral rivaroxaban (20, 30, or 40mg) or standard therapy (LMWH bridge to coumadin). AT 3 months, non-significantly fewer rivaroxaban patients met the primary endpoint (recurrent DVT, PE, or increase in thrombotic burden) (5-7% vs 10% in standard therapy) and non-significantly fewer rivaroxaban patients had bleeding complications (2-6% vs 9% in  standard therapy). Given its apparent equivalency to standard therapy, and that it requires no monitoring, it will likely supplant coumadin therapy in DVT treatment (assuming confirmation in phase III studies).

Danielle Scheurer

Dr. Scheurer is a clinical hospitalist and the Medical Director of Quality and Safety at the Medical University of South Carolina in Charleston, South Carolina, and is Assistant Professor of Medicine. She is a graduate of the University of Tennessee College of Medicine, completed her residency at Duke University, and completed her Masters in Clinical Research at the Medical University of South Carolina. She also serves as the Web Editor and Physician Advisor for the Society of Hospital Medicine.

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