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Johns Hopkins Health Alert

Xarelto: A New Drug for New Joints

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Each year hip and knee replacements give more than 1 million Americans an added spring in their step. Yet despite their success at restoring mobility, hip and knee replacement surgeries carry the risk of serious complications, such as deep vein thrombosis and pulmonary embolism.  Now, hip and knee recipients can avoid postsurgical clots without undergoing painful injections thanks to a new drug, Xarelto. 

In deep vein thrombosis, a blood clot develops within the leg or pelvis. If the clot breaks off and travels to a pulmonary artery, it can block blood flow to the lungs. The clot is then referred to as a pulmonary embolism and can be fatal. 

To prevent deep vein thrombosis and pulmonary embolism, recipients of an artificial hip or knee receive a blood thinner to prevent dangerous clots. Until recently the optimal delivery method was injection -- an unpopular treatment mode because of the pain and inconvenience. 

In July 2011, the Food and Drug Administration green-lighted Xarelto (rivaroxaban) as a means of preventing blood clots in patients receiving a hip or knee replacement. Taken once a day in tablet form, Xarelto inhibits clotting factor Xa. Another factor Xa inhibitor, the widely used Lovenox (enoxaparin), must be injected once or twice a day.

Comparing Xarelto with Coumadin. Xarelto isn't the only blood thinner administered orally. Warfarin (Coumadin), a vitamin K antagonist, is another oral medication designed to reduce the risk of clotting. But Coumadin doesn't work as fast or as consistently as Xarelto and presents a greater risk of complications. Coumadin takes days to reach therapeutic levels, and patients on the drug must be frequently monitored. 

In studies of more than 6,000 individuals on Xarelto, patients on the new blood thinner were 50 percent less likely to have undesirable clotting after knee replacement than those taking Lovenox. Among hip replacement patients, Xarelto users were 3.5 to 4.2 times less likely to experience clotting than Lovenox users. 

Other factor Xa inhibitor drugs prescribed to prevent clotting include generic versions of enoxaparin, fondaparinux (Arixtra), dalteparin (Fragmin) and heparin. Each is delivered by injection only. 

Posted in Arthritis on January 16, 2012


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