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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
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Rivaroxaban concentrations in acute stroke patients with different dosage forms
Shinichi Wada1, Manabu Inoue1, Takayuki Matsuki1
1Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
Plos One
|March 22, 2019
Summary
Rivaroxaban fine granules maintain consistent blood concentrations, similar to tablets, and significantly higher than crushed tablets in acute stroke patients. This suggests comparable efficacy for rivaroxaban fine granules and tablets in anticoagulation therapy.
Area of Science:
- Pharmacology and Therapeutics
- Clinical Pharmacy
- Cardiovascular Medicine
Background:
- Previous studies indicated lower rivaroxaban concentrations with crushed tablets compared to intact tablets.
- The pharmacokinetic profile of rivaroxaban in fine granular form had not been previously investigated.
- Understanding drug formulation impact on concentration is crucial for optimizing anticoagulation therapy in stroke patients.
Purpose of the Study:
- To compare the anticoagulation intensity of rivaroxaban administered as fine granules, intact tablets, and crushed tablets.
- To assess the efficacy of different rivaroxaban formulations in elderly acute stroke patients.
- To investigate the pharmacokinetic differences between rivaroxaban fine granules, tablets, and crushed tablets.
Main Methods:
- A cohort study included hospitalized patients over 75 years old with acute stroke receiving rivaroxaban.
- Rivaroxaban concentrations (C0h, C4h) were measured using an anti-factor Xa chromogenic assay on a median of 5 days post-initiation.
- Patients received either 15 mg or 10 mg doses of rivaroxaban in fine granule, tablet, or crushed tablet forms.
Main Results:
- In the 15 mg dose group, C0h and C4h were significantly higher for fine granules compared to crushed tablets.
- Rivaroxaban concentrations (C0h, C4h) for fine granules were comparable to the tablet group in both 15 mg and 10 mg dose groups.
- The 10 mg dose group showed significantly higher C0h and C4h for fine granules versus crushed tablets, with comparable levels to tablets.
Conclusions:
- Rivaroxaban concentrations achieved with fine granules are consistent with the tablet formulation.
- Fine granular rivaroxaban demonstrates significantly higher drug concentrations compared to the crushed tablet form.
- These findings suggest that rivaroxaban fine granules offer a viable alternative with predictable anticoagulation intensity, similar to intact tablets.
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