From the Guidelines
Yes, a patient with Deep Vein Thrombosis (DVT) of the femoral vein can be treated on an outpatient (OPD) basis with Rivaroxaban (rivaroxaban) [ 1 ].
Key Points
- The CHEST guideline recommends apixaban, dabigatran, edoxaban, or rivaroxaban over vitamin K antagonist (VKA) as treatment-phase anticoagulant therapy for patients with VTE (DVT of the leg or PE) [ 1 ].
- A prospective observational study found that patients with DVT or PE who were treated with rivaroxaban on an outpatient basis had no major bleeding events or episodes of recurrent VTE [ 1 ].
- The recommended dose of rivaroxaban for the treatment of DVT is 15 mg twice daily for 21 days, followed by 20 mg once daily [ 1 ].
- Rivaroxaban has been shown to be effective in preventing recurrent VTE and has a similar rate of major bleeding events compared to warfarin [ 1 ].
Important Considerations
- Patients with severe renal failure, hepatic disease associated with coagulopathy, or those receiving concomitant systemic treatment with azole-antimycotics or HIV protease inhibitors should not be treated with rivaroxaban [ 1 ].
- Rivaroxaban is not approved for use in children or adolescents, pregnant women, or during breast-feeding [ 1 ].
From the Research
Treatment of Deep Vein Thrombosis (DVT) with Rivaroxaban
- Rivaroxaban is an oral, direct factor Xa inhibitor approved for the treatment of acute deep vein thrombosis (DVT) and pulmonary embolism (PE) 2, 3.
- The EINSTEIN clinical trial program demonstrated that rivaroxaban is noninferior to standard therapy (enoxaparin-VKA) in preventing symptomatic recurrent venous thromboembolism (VTE) 3.
- Rivaroxaban can be administered in both hospital and outpatient settings, offering a convenient single-drug approach for the treatment of DVT and PE 2.
Outpatient Treatment of DVT with Rivaroxaban
- Rivaroxaban has been shown to be effective and safe for the treatment of DVT in outpatient settings, with no significant differences in clinically relevant bleeding compared to standard therapy 3.
- A retrospective study involving 406 patients with lower extremity DVT treated with rivaroxaban or edoxaban found no significant differences in major bleeding between the two groups 4.
- Another study found that rivaroxaban was highly effective for total recanalization of localized DVT, but not for symptomatic or extensive DVT 5.
Considerations for Outpatient Treatment
- Patients with extensive DVT may require closer monitoring and consideration of catheter-based thrombolysis in selected cases 5.
- Rivaroxaban's pharmacokinetic profile, including rapid absorption and a relatively short half-life, should be taken into account when administering the medication 4.
- The effectiveness and safety of rivaroxaban in outpatient treatment of DVT should be weighed against individual patient factors, such as renal function and bleeding risk 3, 4.