Rivaroxaban (Xarelto): nouvel anticoagulant oral, inhibiteur direct selectif du facteur Xa.

(Xarelto, Bayer Schering Pharma) is a new anticoagulant with a good oral bioavailability, acting as a potent, selective direct inhibitor of factor Xa. It is indicated in the prevention of venous thromboembolism in adult patients after total hip replacement or total knee replacement surgery. In four large clinical trials (RECORD), oral rivaroxaban was more effective than subcutaneous enoxaparin in preventing postoperative venous thromboembolism in patients undergoing such surgery, and this superior efficacy was achieved without significant increase in the incidence of major bleeding episodes. Rivaroxaban offers several advantages as compared with low-molecular-weight heparin preparations and oral coumarinic agents. Its use is easy with only one 10 mg tablet per day and does not require coagulation blood monitoring or dose adjustment. This promising new anticoagulant is currently evaluated in several clinical trials testing other potential indications, among which acute coronary syndrome and atrial fibrillation.