Kenneth Todd Moore, MS, Dino Kröll, MD

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Presentation transcript:

Influences of Obesity and Bariatric Surgery on the Clinical and Pharmacologic Profile of Rivaroxaban Kenneth Todd Moore, MS, Dino Kröll, MD The American Journal of Medicine Volume 130, Issue 9, Pages 1024-1032 (September 2017) DOI: 10.1016/j.amjmed.2017.05.011 Copyright © 2017 The Authors Terms and Conditions

Figure 1 Mean rivaroxaban plasma concentration-time curve after administration of a single 10-mg oral dose. Each weight group included 12 healthy subjects. Reprinted from Kubitza et al (2007).12 The American Journal of Medicine 2017 130, 1024-1032DOI: (10.1016/j.amjmed.2017.05.011) Copyright © 2017 The Authors Terms and Conditions

Figure 2 Influence of body weight on rivaroxaban-mediated (A) median inhibition of factor Xa activity and (B) median prolongation of prothrombin time. Each weight group included 12 healthy subjects who received a single oral dose of rivaroxaban 10 mg. Reprinted from Kubitza et al (2007).12 The American Journal of Medicine 2017 130, 1024-1032DOI: (10.1016/j.amjmed.2017.05.011) Copyright © 2017 The Authors Terms and Conditions

Figure 3 Relative efficacy of rivaroxaban in weight and body mass index subgroups in large phase 3 clinical trials. Odds/hazard ratios and 95% confidence intervals of the primary efficacy endpoint for the comparison of rivaroxaban with enoxaparin (RECORD studies),21 warfarin (ROCKET AF),20 or enoxaparin/vitamin K antagonist therapy (EINSTEIN studies).28 The American Journal of Medicine 2017 130, 1024-1032DOI: (10.1016/j.amjmed.2017.05.011) Copyright © 2017 The Authors Terms and Conditions

Figure 4 Relative safety of rivaroxaban in weight and body mass index subgroups in large phase 3 clinical trials. Hazard ratios and 95% confidence intervals of the composite endpoint of major bleeding and clinically relevant nonmajor bleeding for the comparison of rivaroxaban with enoxaparin (RECORD studies),21 warfarin (ROCKET AF),20 or enoxaparin/vitamin K antagonist therapy (EINSTEIN studies).28 The American Journal of Medicine 2017 130, 1024-1032DOI: (10.1016/j.amjmed.2017.05.011) Copyright © 2017 The Authors Terms and Conditions

Figure 5 Rivaroxaban plasma concentration-time curve prior to and after bariatric surgery, stratified by procedure type, following administration of single 10-mg oral doses. Panel A represents patients who underwent Roux-en-Y gastric bypass (n = 6) and panel B represents patients who underwent sleeve gastrectomy (n = 6). Reprinted from Kröll et al.38 The American Journal of Medicine 2017 130, 1024-1032DOI: (10.1016/j.amjmed.2017.05.011) Copyright © 2017 The Authors Terms and Conditions

Figure 6 Comparison of pharmacodynamic measures performed following administration of rivaroxaban 10 mg prior to and after bariatric surgery, stratified by procedure type. (A and B) Thrombin-antithrombin complex concentrations; (C and D) prothrombin activation fragment F1+2 concentrations; (E and F) D-dimer concentrations. Data represent medians and ranges for 6 patients who underwent Roux-en-Y gastric bypass and 5 patients who underwent sleeve gastrectomy. Interpretation of the postoperative results must take into consideration the procoagulant state induced by surgical intervention and the administration of low-molecular-weight heparin the previous day as part of the postoperative standard of care. Reprinted from Kröll et al.38 The American Journal of Medicine 2017 130, 1024-1032DOI: (10.1016/j.amjmed.2017.05.011) Copyright © 2017 The Authors Terms and Conditions