VTE in Primary Care: Patient Management With Rivaroxaban
Current guidelines emphasise the desirability of community-based treatment for VTE after initial diagnosis. The simplicity of the rivaroxaban regimen makes it an attractive treatment choice for community pathways, allowing early discharge and early transfer of care to primary care settings. The lack of a need for routine coagulation monitoring has particular advantages in rural areas, increasing the number of patients who can be treated effectively by primary care teams.
Despite the advantages that rivaroxaban therapy provides in treating patients with VTE, there are several factors that general practitioners must consider. The rivaroxaban dosing regimen is an initial 21-day, 15 mg twice-daily dose, followed by a 20 mg once-daily dose for the duration of treatment, and the importance of taking these doses with food must be emphasised.
Although rivaroxaban may favour good patient adherence, a shorter half-life means that it is very important doses are not missed. If a dose is missed during the initial 21-day, 15 mg twice-daily treatment period, patients should take rivaroxaban immediately, and two 15 mg tablets may be taken together. Regular dosing should continue the next day. If a dose is missed during the 20 mg once-daily treatment phase, patients should be advised to take rivaroxaban immediately, and continue treatment as prescribed on subsequent days.
Major bleeding is rare, with an incidence of 1% of rivaroxaban-treated patients in the pooled analyses of EINSTEIN-DVT and EINSTEIN-PE compared with 1.7% in the LMWH/VKA group; however, urgent reversal of the anticoagulant effect of rivaroxaban may be required in occasional circumstances in hospital settings. In primary care, the National Institute for Health and Care Excellence (NICE) recommends that rivaroxaban should not be stopped for minor surgical procedures or minor dental treatments.
Patients taking rivaroxaban should be seen by their physician for regular check-ups to provide reassurance, assess treatment compliance and re-emphasise the importance of adherence to ensure optimal clinical outcomes.
Potential Impact of Rivaroxaban on Primary Care Patient Pathways
Current guidelines emphasise the desirability of community-based treatment for VTE after initial diagnosis. The simplicity of the rivaroxaban regimen makes it an attractive treatment choice for community pathways, allowing early discharge and early transfer of care to primary care settings. The lack of a need for routine coagulation monitoring has particular advantages in rural areas, increasing the number of patients who can be treated effectively by primary care teams.
Practical Implications of the Introduction of Rivaroxaban for VTE Treatment in Primary Care
Despite the advantages that rivaroxaban therapy provides in treating patients with VTE, there are several factors that general practitioners must consider. The rivaroxaban dosing regimen is an initial 21-day, 15 mg twice-daily dose, followed by a 20 mg once-daily dose for the duration of treatment, and the importance of taking these doses with food must be emphasised.
Although rivaroxaban may favour good patient adherence, a shorter half-life means that it is very important doses are not missed. If a dose is missed during the initial 21-day, 15 mg twice-daily treatment period, patients should take rivaroxaban immediately, and two 15 mg tablets may be taken together. Regular dosing should continue the next day. If a dose is missed during the 20 mg once-daily treatment phase, patients should be advised to take rivaroxaban immediately, and continue treatment as prescribed on subsequent days.
Major bleeding is rare, with an incidence of 1% of rivaroxaban-treated patients in the pooled analyses of EINSTEIN-DVT and EINSTEIN-PE compared with 1.7% in the LMWH/VKA group; however, urgent reversal of the anticoagulant effect of rivaroxaban may be required in occasional circumstances in hospital settings. In primary care, the National Institute for Health and Care Excellence (NICE) recommends that rivaroxaban should not be stopped for minor surgical procedures or minor dental treatments.
Patients taking rivaroxaban should be seen by their physician for regular check-ups to provide reassurance, assess treatment compliance and re-emphasise the importance of adherence to ensure optimal clinical outcomes.
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