Hi Everyone,

I was at a conference in April and learned that the use of rivaroxiban was approved (Apr 19) for use in Canada for pulmonary embolus.

This is from bayer:
http://www.bayer.ca/files/NR%20Xarelto%20PE%202013%2004%2018%20FINAL.pdf

What are people thinking about the EINSTEIN Clinical Trial Programme and the implications of rivaroxiban’s approval?

Lets Discuss!

How much of an issue is the lack of reversibility for you given the short half life of this agent?

What would be your enthusiasm for implementing this drug in your practice for this indication? Are longer term studies needed?

Some have criticized the study for having a relatively young average age at 57.9 years but subgroup analysis actually shows greater benefit to the rivaroxaban with those greater than 75 having less bleeding events. Do you feel the sample is representative?

Hi all,

Hope Spring has sprung in your hometown.

For the last session the journal club we will review a paper for the NEJM from 2012, “Oral rivaroxaban for treatment of symptomatic pulmonary embolism”.

This is interesting as it has led to the approval of the medication for this indication in Europe and the USA.  In addition recent articles on apixaban and dabigatran have been published looking at these agents in venous thromboembolism. Please also see references below.

Learning objectives:

1) Review data for new agents for the treatment of thromboembolism

2) Evaluate and comment on the potential use of these agents in your practice

3) Comment on the study of rivaroxaban in pulmonary embolism

ARTICLE:

Oral Rivaroxaban for the Treatment of Symptomatic Pulmonary Embolism. N Engl J Med. 2012;366:1287-1297. Use this link to access the article: https://blogs.ubc.ca/imjournalclub/files/2013/04/Pulmonary-Embolisim.pdf

Additional Readings:

Apixaban for Extended Treatment of Venous Thromboembolism

Giancarlo Agnelli, M.D., Harry R. Buller, M.D., Ph.D., Alexander Cohen, M.D., Madelyn Curto, D.V.M., Alexander S. Gallus, M.D., Margot Johnson, M.D., Anthony Porcari, Ph.D., Pharm.D., Gary E. Raskob, Ph.D., and Jeffrey I. Weitz, M.D. for the AMPLIFY-EXT Investigators

N Engl J Med 2013; 368:699-708February 21, 2013DOI: 10.1056/NEJMoa1207541

Extended Use of Dabigatran, Warfarin, or Placebo in Venous Thromboembolism

Sam Schulman, M.D., Ph.D., Clive Kearon, M.D., Ajay K. Kakkar, M.B., B.S., Ph.D., Sebastian Schellong, M.D., Henry Eriksson, M.D., Ph.D., David Baanstra, M.Sc., Anne Mathilde Kvamme, M.Sc.Pharm., Jeffrey Friedman, M.D., Patrick Mismetti, M.D., and Samuel Z. Goldhaber, M.D. for the RE-MEDY and the RE-SONATE Trials Investigators

N Engl J Med 2013; 368:709-718 February 21, 2013DOI: 10.1056/NEJMoa1113697

Please stay tuned! Session 5 will run for six weeks starting on April 10, 2013.

Session 5 topic Pulmonary Embolism.