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American Journal of Medicine
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American Journal of Medicine
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Figure 16 shows the doses that were studied in the randomized control trials (RCTs) with rivaroxaban and dabigatran. [9] [10] [11] [12] The important point here is that the rivaroxaban dose changes after 3 weeks, so that in the EINSTEIN Acute DVT trial the drug was started at 15 mg twice a day for 3 weeks followed by 20 mg once daily.[9] This is a critical point for your hospital or practice: patients who are prescribed rivaroxaban must be tracked and required to return at 3 weeks so that they do not continue taking 15 mg twice daily for the entirety of their treatment course. This means that the transition from hospital to outpatient needs to be tightened and patients must be made aware that there will be a reduction in dose at around that 3-week mark.
On the other hand, dosing with dabigatran for VTE is similar to the atrial fibrillation treatment dose, which for most individuals is going to be 150 mg twice daily.[11] [12] Hylek E. Am J Med 2013; published on-line at http://education.amjmed.com/00000.
[9] The EINSTEIN Investigators. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med. 2010;363:2499-2510.
[10] EINSTEIN-PE Investigators. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med. 2012;366:1287-1289.
[11] Schulman S, Kearon C, Kakkar AK, et al; for the RE-COVER Study Group. Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med. 2009;361:2342-2352.
[12] Schulman S, Kakkar AK, Schellong SM, et al. A Randomized Trial of Dabigatran Versus Warfarin in the Treatment of Acute Venous Thromboembolism (RE-COVER II). Blood (ASH Annual Meeting Abstracts). 2011;118: Abstract 205.