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Venous thromboembolism

EINSTEIN transforms anticoagulant therapy in acute PE

The EINSTEIN-PE trial showed that rivaroxaban has equal efficacy and a lower rate of bleeding than coumarins in the treatment of acute pulmonary embolism. We anticipate regulatory and consumer acceptance for rivaroxaban, representing the first new anticoagulant treatment for venous thromboembolism since the introduction of warfarin compounds 50 years ago.

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Figure 1: Effect of rivaroxaban on clotting.

References

  1. Büller, H. R. et al. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N. Engl. J. Med. 366, 1287–1297 (2012).

    Article  Google Scholar 

  2. Lee, A. & Crowther, M. Practical issues with vitamin K antagonists: elevated INRs, low time-in-therapeutic range, and warfarin failure. J. Thromb. Thrombolysis 31, 249–258 (2011).

    Article  CAS  Google Scholar 

  3. Ageno, W. et al. Oral anticoagulant therapy: antithrombotic therapy and prevention of thrombosis, 9th ed.: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 141 (2 Suppl.), e44S–e88S (2012).

    Article  CAS  Google Scholar 

  4. Samama, M. M. et al. Assessment of laboratory assays to measure rivaroxaban—an oral, direct factor Xa inhibitor. Thromb. Hemost. 103, 815–825 (2010).

    Article  CAS  Google Scholar 

  5. Samama, M. M. et al. Evaluation of the anti-factor Xa chromogenic assay for the measurement of rivaroxaban plasma concentrations using calibrators and controls. Thromb. Hemost. 107, 379–387 (2012).

    Article  CAS  Google Scholar 

  6. Deitelzweig, S. et al. Medical cost reductions associated with the usage of novel oral anticoagulants vs. warfarin among atrial fibrillation patients, based on the RE-LY, ROCKET-AF and ARISTOTLE trials. J. Med. Econ. http://dx.doi.org/10.3111/13696998.2012.680555.

  7. Holbrook, A. et al. Evidence-based management of anticoagulant therapy: antithrombotic therapy and prevention of thrombosis, 9th ed.: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 141 (2 Suppl.), e152S–e184S (2012).

    Article  CAS  Google Scholar 

  8. Ninjkeuter, M., Hovens, M. M., Davidson, B. L. & Huisman, M. V. Resolution of thromboemboli in patients with acute pulmonary embolism: a systematic review. Chest 129, 192–197 (2006).

    Article  Google Scholar 

  9. Kline, J. A. & Miller, D. W. Risk stratification for acute pulmonary embolism. J. Natl Compr. Canc. Netw. 9, 800–810 (2011).

    Article  CAS  Google Scholar 

  10. Jaff, M. R. et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation 123, 1788–1830 (2011).

    Article  Google Scholar 

Download references

Acknowledgements

The work was supported by Awards Number 1R01HL085565-01 and 1K12 HL109068-01 from the National Heart, Lung, and Blood Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute or the National Institutes of Health.

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Correspondence to Jeffrey A. Kline.

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J. A. Kline has received grant support from the Agency for Healthcare Research and Quality and Genentech. He is a stock holder in CP Diagnostics LLC. D. M. Yealy has received grant support from the National Institutes of Health.

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Kline, J., Yealy, D. EINSTEIN transforms anticoagulant therapy in acute PE. Nat Rev Cardiol 9, 378–380 (2012). https://doi.org/10.1038/nrcardio.2012.65

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