Indicaciones de rivaroxabán en diferentes situaciones clínicas

Barrios Alonso, V.; Escobar, C.

doi:10.1016/S1138-3593(13)74378-8

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Resumen

Rivaroxabán es un inhibidor oral directo y altamente selectivo del factor Xa de la coagulación. Los principales resultados del ROCKET-AF mostraron que en pacientes de alto riesgo con fibrilación auricular no valvular, rivaroxabán fue no inferior a la warfarina en la prevención del ictus o embolia sistémica, pero con un menor riesgo de intracraneales, fatales y en órgano crítico. Rivaroxabán ha demostrado ser eficaz y seguro en pacientes con insuficiencia renal, en pacientes ancianos, así como en aquellos con cardiopatía isquémica o ictus previo.

Rivaroxabán se toma una sola vez al día. En comparación con los otros nuevos anticoagulantes orales (ACO), rivaroxabán puede proporcionar un mejor cumplimiento y adherencia al tratamiento y, en consecuencia, reducir el riesgo de ictus durante el seguimiento. Además, las interacciones con otros fármacos son escasas. Esto, junto con que es de una sola toma diaria, hace que rivaroxabán suponga una excelente alternativa para la prevención de los episodios tromboembólicos en los pacientes polimedicados con fibrilación auricular.

En este manuscrito se revisa la evidencia disponible acerca de la eficacia y seguridad de rivaroxabán en los pacientes con fibrilación auricular en diferentes escenarios clínicos.

Palabras clave:

Rivaroxabán

Fibrilación auricular

Insuficiencia renal

Cardiopatía isquémica

Ictus

Una vez al día

Adherencia al tratamiento

Ancianos

Abstract

Rivaroxaban is an oral highly selective direct factor Xa inhibitor. The main results of ROCKET-AF showed that in high risk patients with nonvalvular atrial fibrillation, rivaroxabán was noninferior to warfarin for the prevention of stroke or systemic embolism, but with lesser risk of intracranial and fatal bleeding. Remarkably, rivaroxaban has been proven to be effective and safe in patients with renal dysfunction, elderly patients as well as in those with ischemic heart disease or previous stroke.

Rivaroxaban is taken only once daily. Compared with other new oral anticoagulants, this may provide better compliance and medication adherence and, consequently, a reduction in the risk of stroke during the follow-up. Moreover, the interactions with other drugs are low. This together with the once daily dose makes rivaroxabán an excellent alternative for the prevention of thromboembolic events in polymedicated patients with atrial fibrillation.

This manuscript reviews the available evidence about the efficacy and safety of rivaroxabán in patients with atrial fibrillation in different clinical settings.

Keywords:

Rivaroxabán

Atrial fibrillation

Renal insufficiency

Ischemic heart disease

Stroke

Once-daily

Medication adherence

Elderly

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