Rivaroxaban Guidelines

PharmlyDoc

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    Professors posted notes stating that for VTE treatment, rivaroxaban is dosed at 15 mg PO bid for 21 days, then 20 mg PO daily...I can't find this stated anywhere on pubmed or CHEST guidelines. I was more hoping to find it in CHEST guidelines. I know the package insert states the dosage and treatment duration for VTE, but where is it in the primary literature?!
     

    PharmlyDoc

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      Harrison's internal medicine states "For treatment of patients with DVT or PE, rivaroxaban is started at a dose of 15 mg twice daily for 3 weeks; the dose is then reduced to 20 mg once daily thereafter." But for how long? And what clinical trials are they getting this information from
       
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      cbrons

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        Met the XARELTO® (rivaroxaban)‎ drug reps last week. They brought a nice platter to the hospital to peddle their drug, hand out coupons, etc. I loved it especially when one girl in my class who is an ultra left-wing psycho (redundant I know) got angry at peeps for taking food from the drug reps.
         
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          Met the XARELTO® (rivaroxaban)‎ drug reps last week. They brought a nice platter to the hospital to peddle their drug, hand out coupons, etc. I loved it especially when one girl in my class who is an ultra left-wing psycho (redundant I know) got angry at peeps for taking food from the drug reps.

          Lol it's just food she doesn't have to eat it if she doesn't want to. I wouldn't prescribe it because no antidote and I've seen enough gi bleeds to make me wary but i have no qualms about eating what they bring
           

          TooMuchResearch

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            Harrison's internal medicine states "For treatment of patients with DVT or PE, rivaroxaban is started at a dose of 15 mg twice daily for 3 weeks; the dose is then reduced to 20 mg once daily thereafter." But for how long? And what clinical trials are they getting this information from

            Don't get doses from textbooks.
             
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            W19

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              Met the XARELTO® (rivaroxaban)‎ drug reps last week. They brought a nice platter to the hospital to peddle their drug, hand out coupons, etc. I loved it especially when one girl in my class who is an ultra left-wing psycho (redundant I know) got angry at peeps for taking food from the drug reps.
              If you check 'CMS Open Payment' website, you will notice that there are physicians that got over $3000 worth of food from big pharma... >$3000 worth of food in one year! Seriously!
               
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              W19

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                it's really not much, considering where the reps take them out for dinners/drinks during conference trips
                If you have 60-70 transactions in your record, that means you pretty much getting meals from big pharma once a week average. I have no problem with that by the way... I went to a couple of these dinners, and they were at nice places. One the reps kept telling me that they will be having other get together next week/month and that I should come.... I said to myself why she is insisting for me to come when I am just a lowly med student? Big pharma marketing campaign is extremely aggressive.
                 

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                  If you check 'CMS Open Payment' website, you will notice that there are physicians that got over $3000 worth of food from big pharma... >$3000 worth of food in one year! Seriously!

                  When drug reps come by they feed your whole office. It's not like the doc is chowing down on filet mignon by themselves
                   
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                  VA Hopeful Dr

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                    Yeah, the point here is that the manufacturer decided on the dosing schedule. All the research done since FDA approval has been with the FDA approved dosing schedule. That's why CHEST doesn't mention dosing. Same reason it doesn't mention dosing for Plavix - there's only 1 dose.
                     

                    mimelim

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                      If you check 'CMS Open Payment' website, you will notice that there are physicians that got over $3000 worth of food from big pharma... >$3000 worth of food in one year! Seriously!

                      If you look me up on there... >$2000. Pretty much all of our residents are in that range, evenly divided among 6-7 device companies. They cover dinners, conference breakfasts, travel expenses for conferences, books, study materials, etc. I know of groups that compete to see who can get them to pay for the most stuff in one year. Most of our attendings are ~10k/year, one is 60k+. Then in our field you have Tim Chuter... https://openpaymentsdata.cms.gov/physician/227470 ;)

                      Most of our dinners are ~$120-150 per person, it adds up quickly, especially if you are attending multiple conferences and are being taken out by different groups 3-4 nights in a row.
                       
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                      PL198

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                        If you have 60-70 transactions in your record, that means you pretty much getting meals from big pharma once a week average. I have no problem with that by the way... I went to a couple of these dinners, and they were at nice places. One the reps kept telling me that they will be having other get together next week/month and that I should come.... I said to myself why she is insisting for me to come when I am just a lowly med student? Big pharma marketing campaign is extremely aggressive.

                        or she was just being nice and offering to give you a free dinner because you have no money.... most of these things are educational, maybe help the docs learn about a new product or two and definitely improve patient care.
                         

                        PharmlyDoc

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                          Probably 3 months then
                          But why? If your patient had just had a PE for the first time, WF, 51 years old. No significant medical Hx other than smoker. Upon discharge you would start her on 15mg tablet rivaroxaban PO BID for 21 days, then 20 mg tablet PO daily...but why 3 months, or why 6 months. I've seen a hematologist prescribe 15 mg PO BID for 21 days then 20 mg daily for 6 months then 81 mg ASA for life for a young healthy male who randomly had a DVT/PE due to prothrombin mutation.
                           

                          Kaustikos

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                            Harrison's internal medicine states "For treatment of patients with DVT or PE, rivaroxaban is started at a dose of 15 mg twice daily for 3 weeks; the dose is then reduced to 20 mg once daily thereafter." But for how long? And what clinical trials are they getting this information from
                            That's what everyone uses here. Especially vascular. Plus no INR checks.
                             
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