11 responses to “Rivaroxaban for treatment of symptomatic pulmonary embolism: exploring new territories”

  1. Good article.

  2. Hope to see practice guidelines reflect use of new agents soon

  3. This is a very promising development due to the ease of the new treatment. I will likely, however, watch for a year or two and watch for unexpected problems before switching from a very well established practice with warfarin.

  4. the attraction to R is clear, no INRs no adjustments, a lot of physician hours saved. Cost is the big factor and until that is settled Warfarin will continue to plague my office

  5. Will be good to have studies not sponsored by pharma industry.

  6. I have used Dabagatrin in some of my patients, however have recently stopped as one of my internal medicine colleagues pointed out it’s non-reversability. Is Rivaroxaban similiarly irreversible?

  7. It would have been nice if you had mentioned in the article the actual cost of both Warfarin and Rivaroxaban

  8. It appears that warfarin is at least as good as rivaroxaban and much less expensive.

  9. certainly an option for the appropriate patient

  10. As admin cuts back on the services needed to transition a patient diagnosed in ED through LMWH to warfarin (home care nurse for injections, lab outreach for daily INR) ED physicians will find the immediate onset of very expensive warfarin substitutes hard to resist though the long term cost to the system will be much greater. Penny wise and pound foolish. This applies more to DVT (usually Rx as OP) than PE

  11. Thanks everyone for the comments. To answer some questions, Rivaroxaban is felt to be irreversible–similar to dabigatran. However, there is one small study showing prothrombin complex (PCC) was successful in reversing Rivaraoxaban in 6 healthy male volunteers who took the drug for 2.5 days. That is the best evidence so far. Not strong enough (in my mind) to truly say this is an acceptable reversing agent. Also, outside of a major centre, getting PCC in a timely manner is unlikely. So I still say irreversible.

    As for cost….1 month of Rivaraxaban 20 mg daily is $210.

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