Dr. David J. Moliterno on Rivaroxaban: "Greatest use has been Atrial Fibrillation."

Описание: In an interview with Dr. Vishal Rastogi at IndiaLive24, Dr. David J. Moliterno discusses rivaroxaban’s role in antithrombotic therapy, explaining that it targets the coagulation cascade rather than platelets.

He says, "Rivaroxaban has been shown to be of benefit among some patients... most of the benefit and the greatest use has been atrial fibrillation."

While antiplatelet therapies remain the focus for acute coronary syndromes, he notes, "After an acute coronary syndrome and in patients with peripheral arterial disease, some benefit can be seen."
For patients needing both oral anticoagulants and antiplatelets, he explains, "We will very specifically remove aspirin and go to dual antithrombotic therapy, almost always clopidogrel along with apixaban or rivaroxaban."
This approach helps minimize bleeding risks, as he adds, "We can shorten the course of dual therapy if the patient is at particularly high bleeding risk."

Dr. David J Moliterno
Professor of Medicine, Dept of Internal Medicine
University of Kentucky,
Lexington, Kentucky

Dr. Vishal Rastogi
Director of Interventional Cardiology and Head of Advanced Heart Failure Management,
Fortis Healthcare,
New Delhi


Transcript:

Dr. Vishal Rastogi:
there's data on rivaroxaban also in these populations. What is your take on it?

Dr. David J. Moliterno:
that's a whole other side of the antithrombotic formula, and that's going after the coagulation cascade itself. And so rivaroxaban has been shown to be of benefit among some patients. I think most of the benefit and the greatest use has been atrial fibrillation. But after an acute coronary syndrome, there's some benefit seen, and also in patients who have peripheral arterial disease, some benefit can be seen.

I think the greater emphasis has been on antiplatelet therapies for acute coronary syndromes, but certainly, the oral anticoagulants, such as rivaroxaban, have been shown to be of some benefit. I think that segues now to the next part, and it's patients
do have an indication for an oral anticoagulant, be it apixaban, rivaroxaban, or coumadin, largely for atrial fibrillation, but who also have a need for antiplatelet therapy because of a drug-eluting stent being placed.

And that's a time when we will very specifically remove the aspirin and go to what's called dual antithrombotic therapy, meaning with a single antiplatelet, almost always clopidogrel rather than aspirin, or one of the more potent agents, along with apixaban or rivaroxaban. And there, too, we can shorten the course of that dual antithrombotic therapy if needed if the patient is at particularly high bleeding risk.

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