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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Br+J+Clin+Pharmacol
2016 ; 81
(4
): 724-34
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Rivaroxaban compared with standard thromboprophylaxis after major orthopaedic
surgery: co-medication interactions
#MMPMID26580706
Kreutz R
; Haas S
; Holberg G
; Lassen MR
; Mantovani LG
; Schmidt A
; Turpie AG
Br J Clin Pharmacol
2016[Apr]; 81
(4
): 724-34
PMID26580706
show ga
AIM: The aim of the present study was to analyse concomitant drug use and its
association with outcome in patients (N = 17 701) receiving rivaroxaban or
standard of care (SOC) for the prevention of venous thromboembolism after major
orthopaedic surgery in the non-interventional, phase IV XAMOS (Xarelto® in the
prophylaxis of post-surgical venous thromboembolism after elective major
orthopaedic surgery of hip or knee) study. METHODS: Concomitant drug use was at
the discretion of the treating physician. Prespecified co-medications of interest
were cytochrome P450 (CYP) 3A4/P-glycoprotein inhibitors/inducers, platelet
aggregation inhibitors (PAIs) and nonsteroidal anti-inflammatory drugs (NSAIDs).
Crude event incidences were compared between rivaroxaban and SOC groups. RESULTS:
CYP3A4/P-glycoprotein inhibitor/inducer use was infrequent, in contrast to PAI
(~7%) and NSAID (~52%) use. Rivaroxaban was associated with a lower incidence of
overall symptomatic thromboembolic events compared with SOC, regardless of
co-medication use. In both treatment groups, PAI users, with higher age and
prevalence of cardiovascular co-morbidities, had similar higher (>7-fold)
incidences of symptomatic arterial but not venous thromboembolic events compared
with non-users. NSAID use had no influence on thromboembolic events. However,
odds ratios (ORs) for major bleeding events (European Medicines Agency
definition) were higher in NSAID users compared with non-users in rivaroxaban
[OR = 1.50; 95% confidence interval (CI) 1.06, 2.13] and SOC (OR = 1.70; CI 1.16,
2.49) groups. In PAI users, ORs for major bleeding events were no different from
those of non-users in both the rivaroxaban (OR = 1.49; CI 0.84, 2.65) and SOC
(OR = 1.46; CI 0.82, 2.62) groups. CONCLUSIONS: Use of NSAIDs in XAMOS was
frequent and associated with a higher frequency of bleeding events in patients
receiving rivaroxaban or SOC, although the benefit-risk profile of rivaroxaban
compared with SOC was maintained.
|Aged
[MESH]
|Anticoagulants/administration & dosage/adverse effects/*therapeutic use
[MESH]
|Arthroplasty, Replacement, Hip/*methods
[MESH]
|Arthroplasty, Replacement, Knee/*methods
[MESH]
|Cohort Studies
[MESH]
|Drug Interactions
[MESH]
|Female
[MESH]
|Hemorrhage/chemically induced
[MESH]
|Humans
[MESH]
|Male
[MESH]
|Middle Aged
[MESH]
|Rivaroxaban/administration & dosage/adverse effects/*therapeutic use
[MESH]