wing orthopedicsurgery also as in treating acute proximal DVT. Ineach study, the authors concluded that once-daily or twice-dailyrivaroxaban was as efficacious as standard therapy with similarsafety profiles.45–48 In 2009, however, the FDA sought moreinformation on this agent.RECORD. The REgulation of Coagulation in key CX-4945 Orthopedicsurgery decreasing the Risk of DVT and PE plan comprisesfour phase 4 clinical trials investigating the safety andefficacy of rivaroxaban as thromboprophylaxis in far more than12,000 patients undergoing total hip or knee arthroplasty.49–52 In every study, rivaroxaban was offered as 10 mgonce dailyand wascompared with either enoxaparin 40 mg SQ once dailyor enoxaparin 30 mg SQ twice daily.? RECORD 1 analyzed the thromboprophylaxis potential ofrivaroxaban following total hip replacement.
The resultsshowed a statistically significant reduction within the total incidenceof VTEwith no differencein totalnon-majorbleeding.49? RECORD 2 evaluated the long-term prophylaxis of rivaroxabanversus the short-term prophylaxis of enoxaparinfollowing total hip replacement. When offered for 31 to 39days, rivaroxaban was far more effectivethanenoxaparin offered for 10 CX-4945 to 14 days. Despite the fact that there was anincreased risk of bleeding within the rivaroxaban group, it wasnot significant.50? RECORD 3 and RECORD 4 were performed to assessVTE prophylaxis following total knee arthroplasty. InRECORD 3, there was a significantdecreasein VTE incidence when rivaroxaban was offered for 10 to 14days versus enoxaparin, and key bleeding rates weresimilar in between groups.
? In RECORD 4, rivaroxaban once daily was discovered to be superiorto enoxaparin twice dailyin VTE prophylaxisfollowing axitinib knee arthroplasty. Safety profiles weresimilar.52A prespecified pooled analysis from the RECORD programwas performed in order to ascertain regardless of whether there was aneffect on crucial NSCLC clinical outcomes. The authors had postulatedthat the total number of events could be lower in theindividual trials. Results from the analysis showed that once-dailyrivaroxaban, compared with enoxaparin, considerably improvedcomposite outcomes of symptomatic VTE, cardiovascularevents, all-cause mortality, and key bleeding events.53Patients receiving rivaroxaban had a 58% reduction in symptomaticVTE and all-cause mortalityfor the total therapy duration as well as a 52% reduction in theactive therapy pool, with no significantincreased risk of key bleeding.
53In terms of adverse events, the RECORD plan showeda nonsignificant elevation in hepatic enzymesin the rivaroxaban group.49–51Preliminary phase 1 studies reported nonsignificant incidencesof headache, diarrhea, fatigue, flatulence, and dizzinesswith rivaroxaban, but these effects were not quantified in latertrials.29 Interactions typically noticed with current anticoagulantsand axitinib medicines, including digoxin, naproxen, aspirin, clopidogrel, and abciximabdo not affectrivaroxaban. Much more studies are required to evaluate the effect offood as well as other drugs on rivaroxaban’s pharmacokinetics andpharmacodynamics.29EINSTEIN. Rivaroxaban is undergoing further phase 3clinical trials for added indications. For VTE therapy, theEinstein programis conducting threeadditional studies.
54 The DVT and PE trials CX-4945 are investigating rivaroxaban15 mg twice daily for three weeks, followed by 20 mg oncedaily, versus enoxaparin 1 mg/kg twice daily for a minimum of fivedays, followed by warfarin.The extension study compares rivaroxaban 20 mg daily withplacebo for six to 12 months.27 Although the PE study is ongoing,data from the DVT and extension studies have been published.In trying to find the incidence of current VTE, the researchersnoted that rivaroxaban was non-inferior to enoxaparin– warfarinin the DVT study and superior toplaceboin the extension study.55ROCKET–AF. Rivaroxaban 20 mg dailyis becoming compared with warfarinfor stroke prevention in patients with atrial fibrillation. This trialis scheduled to last a maximumof four years, based on the occurrence of adverseevents.
27MAGELLAN. Rivaroxaban 10 mg daily for 35 days wascompared with enoxaparin 40 mg daily for 10 days in 8,000medically ill patients.27 This trialhas been completed.ATLAS–ACS TIMI 51. Rivaroxaban 2.5 or 5 mg twice dailytaken for six months was compared with placebo for the preventionof post-ACS cardiac axitinib events.27 TheAnti-Xa Therapy toLower cardiovascular events in addition to aspirin with/withoutthienopyridine therapy in Subjects with Acute CoronarySyndrome–Thrombolysis in Myocardial Infarction trial iscompleted.ApixabanApixabanis a different oral, direct aspect Xa inhibitorundergoing clinical trials for the prevention and treatmentof VTE, stroke prevention secondary to atrial fibrillation,and secondary prophylaxis in acute coronary syndromes.4The oral bioavailability of apixaban is 50% to 85%. Peak plasmaconcentrations are reached in three hours.The agent’s terminal half-life is eight to 15 hours, and it ismetabolized mainly through the CYP 450 isoenzyme 3A4. It isexcreted through the kidneysand feces.56–58 It
Saturday, April 20, 2013
This Is The axitinib CX-4945 Truth Your Parents Doesn't Want You To Find Out About!
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A66 CX-4945,
axitinib,
GS-1101
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