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Have we discussed this yet?
Rivaroxaban
- Thread starter spacecowgirl
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Cheaper then lovenox, its oral, and may be more beneficial to give.
The liver disease complications need to be more closely studied
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Good alternative for patients with renal dysfunction unable to safely use dabigatran (I'd be much more comfortable using this drug in patients with moderate renal impairment, regardless of what the PI for dabigatran says). Much more user-friendly than enoxaparin, so that's a plus.
As a poster mentioned above, I don't think the book is closed on hepatic dysfunction. It's an oxazolidinone derivative, just like linezolid, so I think there are going to be rare mytochondrial toxicities, including neuropathy, hepatic dysfunction and bone marrow suppression. The pre-marketing studies and in vitro data say that rivaroxaban doesn't have binding affinity for mitochondrial DNA, but I'm not convinced - especially when it starts being used off-label on a long-term basis.
As a poster mentioned above, I don't think the book is closed on hepatic dysfunction. It's an oxazolidinone derivative, just like linezolid, so I think there are going to be rare mytochondrial toxicities, including neuropathy, hepatic dysfunction and bone marrow suppression. The pre-marketing studies and in vitro data say that rivaroxaban doesn't have binding affinity for mitochondrial DNA, but I'm not convinced - especially when it starts being used off-label on a long-term basis.
We had a new grad from the UK come to our hospital for a few days as part of some exchange program, he asked if we use it. They've had it for some time now and use it quite a bit apparently. Rocket-AF didn't blow my mind, but it's another option.
As for our current on-label post-op ortho, I like how they specify durations. Too often you see docs anticoagulate for days or so with lovenox, then just send the pt home on aspirin. No real consistency in the regimens. Here we have a specific length of time for them to be treated.
Also, that black box warning about epidural anesthesia can be a big problem for the docs who like to use that for their ortho surgeries. You have to pull it out >18 hours after the last dose, but can't give another dose <6 hours after you pull it out. Seems like a huge thing you'd have to put warnings all over the place so nurses were following this, but then again sometimes 8:00 meds aren't given until 10...
As for our current on-label post-op ortho, I like how they specify durations. Too often you see docs anticoagulate for days or so with lovenox, then just send the pt home on aspirin. No real consistency in the regimens. Here we have a specific length of time for them to be treated.
Also, that black box warning about epidural anesthesia can be a big problem for the docs who like to use that for their ortho surgeries. You have to pull it out >18 hours after the last dose, but can't give another dose <6 hours after you pull it out. Seems like a huge thing you'd have to put warnings all over the place so nurses were following this, but then again sometimes 8:00 meds aren't given until 10...
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