{"id":4240,"date":"2010-11-01T17:05:31","date_gmt":"2010-11-01T21:05:31","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?p=4240"},"modified":"2011-07-19T17:45:25","modified_gmt":"2011-07-19T21:45:25","slug":"rocket-af-is-rivaroxaban-ready-for-blast-off","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2010\/11\/01\/rocket-af-is-rivaroxaban-ready-for-blast-off\/","title":{"rendered":"ROCKET AF: Is Rivaroxaban Ready for Blast Off?"},"content":{"rendered":"<p>With the approval of dabigatran and now <a href=\"http:\/\/blogs.nejm.org\/cardioexchange\/rivaroxaban-equals-warfarin-in-rocket-af\/\">the preliminary and partial results of ROCKET AF<\/a>, we&#8217;ll\u00a0 need to be familiar with much more than just warfarin to address the anticoagulation needs of our patients. The early word on ROCKET AF, which will be presented at AHA, is that\u00a0rivaroxaban is at least as effective as warfarin in preventing stroke and non-CNS embolic events in patients with nonvalvular atrial fibrillation.<\/p>\n<p>What is\u00a0rivaroxaban? It is a direct factor Xa inhibitor that inhibits the conversion of prothrombin to thrombin \u2014 and thrombin is what converts fibrinogen to fibrin. You may remember that factor X is the final common pathway of the intrinsic and extrinsic pathways, placing it at a critical position in the cascade.<\/p>\n<p>Rivaroxaban was approved in 2008 in Canada and Europe for the purpose of preventing venous thrombosis after hip and knee replacement surgery. An FDA panel in 2009 recommended the same for the U.S.<\/p>\n<p>Now we await the ROCKET AF presentation. The key questions will be:<\/p>\n<ul>\n<li>Were the event rates comparable to what might be expected in practice \u2014 or is there evidence that the study population was highly selected?<\/li>\n<li>Was the warfarin treatment optimized? How well was the INR maintained?<\/li>\n<li>Are there any safety concerns with rivaroxaban? How do bleeding rates compare?<\/li>\n<li>Is there any suggestion that the drug is particularly good or bad for a particular subgroup? This would be an exploratory analysis and would not likely be considered definitive.<\/li>\n<li>Is there any evidence that rivaroxaban is more effective than warfarin?<\/li>\n<\/ul>\n<p>And then, if at the end of the day, rivaroxaban really looks to be no better than warfarin \u2014 will it find a niche in clinical care?<\/p>\n","protected":false},"excerpt":{"rendered":"<p>With the approval of dabigatran and now the preliminary and partial results of ROCKET AF, we&#8217;ll\u00a0 need to be familiar with much more than just warfarin to address the anticoagulation needs of our patients. The early word on ROCKET AF, which will be presented at AHA, is that\u00a0rivaroxaban is at least as effective as warfarin [&hellip;]<\/p>\n","protected":false},"author":211,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[495,13,1,7],"tags":[492,510,366,368],"class_list":["post-4240","post","type-post","status-publish","format-standard","hentry","category-anticoagulation-2","category-electrophysiology","category-general","category-prevention","tag-anticoagulation","tag-factor-xa-inhibitors","tag-rivaroxaban","tag-warfarin"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/4240","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/211"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=4240"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/4240\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=4240"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=4240"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=4240"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}