• Thrombosis research · Jan 2007

    Randomized Controlled Trial Multicenter Study

    Dose-escalation study of rivaroxaban (BAY 59-7939)--an oral, direct Factor Xa inhibitor--for the prevention of venous thromboembolism in patients undergoing total hip replacement.

    • Bengt I Eriksson, Lars C Borris, Ola E Dahl, Sylvia Haas, Menno V Huisman, Ajay K Kakkar, Frank Misselwitz, Eva Muehlhofer, and Peter Kälebo.
    • Department of Orthopaedics, Sahlgrenska University Hospital/Ostra, SU/Ostra sjukhuset, SE-41685 Goteborg, Sweden. b.eriksson@orthop.gu.se
    • Thromb. Res. 2007 Jan 1;120(5):685-93.

    IntroductionRivaroxaban (BAY 59-7939) is a novel, oral, direct Factor Xa inhibitor in clinical development for the prevention of thromboembolic disorders. The aim of this study was to demonstrate proof-of-principle for rivaroxaban.Materials And MethodsThis was an open-label, dose-escalation study to assess the efficacy and safety of rivaroxaban, relative to enoxaparin, for the prevention of venous thromboembolism (VTE) after total hip replacement surgery. Patients were randomized in a 3:1 ratio to rivaroxaban (2.5, 5, 10, 20 and 30 mg twice daily [bid] or 30 mg once daily [od] starting 6-8 h after surgery) or enoxaparin (40 mg od starting the evening before surgery). Therapy continued until mandatory bilateral venography was performed 5-9 days after surgery.ResultsA total of 625 patients received therapy, of whom 466 patients were eligible for the per-protocol efficacy analysis. The primary efficacy endpoint - deep vein thrombosis (DVT), pulmonary embolism (PE) or all-cause mortality - occurred in 22.2%, 23.8%, 20.0%, 10.2%, 17.4%, 15.1% and 16.8% of patients receiving rivaroxaban 2.5, 5, 10, 20, 30 mg bid, 30 mg od and enoxaparin, respectively. The dose-response relationship with rivaroxaban for the primary efficacy endpoint was not statistically significant (p=0.0504), although major VTE (proximal DVT, PE and VTE-related death) decreased dose dependently with rivaroxaban (p=0.0108). Major, post-operative bleeding increased dose dependently with rivaroxaban (p=0.0008), occurring in 0-10.8% of patients, compared with 0% in patients receiving enoxaparin.ConclusionsThis study demonstrated proof-of-principle for rivaroxaban for the prevention of VTE after total hip replacement surgery.

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