Introduction
Rivaroxaban, chemically known as 5-chloro-N-({(5S)-2-oxo-3-[4-(3-oxomorpholin-4-yl)phenyl]-1,3-oxazolidin-5-yl}methyl)thiophene-2-carboxmide, is an odorless, non-hygroscopic, white to yellowish powder, which is only slightly soluble in organic solvents and practically insoluble in water. Rivaroxaban is an orally active direct factor FXa inhibitor drug which can catalyze the cleavage of prothrombin and thus possesses an anticoagulant activity and the inhibition of thrombin generation. Therefore, rivaroxaban as antithrombotic drug is widely described to treat and prevent various thromboembolic diseases. The structure of rivaroxaban is showed in Figure 1.
Application in the treatment of thromboembolic diseases
Rivaroxaban is a prescription medicine for treatment of thromboembolic diseases mainly used to treat and prevent the symptoms of the deep vein thrombosis (DVT) prior to hip or knee replacement surgery, treat the venous thromboembolism (VTE) and nonvalvular atrial fibrillation, and treat DVT and pulmonary embolism (PE).
Since approved for medical use in the United States in 2011, rivaroxaban has been studied and used in the treatment of thrombosis for years. Here we mainly introduce its application in the treatment of thrombosis.
- Introduction of thrombosis
Thrombosis is the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel (a vein or an artery) is injured, the body uses platelets (thrombocytes) and fibrin to form a blood clot to prevent blood loss. Even when a blood vessel is not injured, blood clots may form in the body under certain conditions. A clot, or a piece of the clot, that breaks free and begins to travel around the body is known as an embolus.
Factor Xa (FXa) is an enzyme belonging to the serine protease family which plays a vital role in hemostasis, being an essential part in the blood-clotting cascade by catalyzing the thrombin and clot production, and wound closure. When you have a cut or when you are not moving and your blood becomes sluggish, clotting factors and platelets work together to form a clot or thrombus. Although this natural process helps you stop bleeding when you have a cut, it can be harmful when blood clots develop in the arms, legs, or lungs. Figure 2 shows three types of thrombosis.
- Mechanism of action
The action mechanism of rivaroxaban for treatment of thromboembolic diseases can briefly describe as follow: Rivaroxaban is a selective inhibitor of FXa, it does not require a cofactor (such as Anti-thrombin III) for activity and can directly inhibit both free and bound factor FXa in the prothrombinase complex. By inhibiting FXa, rivaroxaban decreases thrombin generation, interrupts the intrinsic and extrinsic pathway of the blood coagulation, and then it inhibits the thrombin as well thrombi formation (Figure 3).
- Side effects
Like all medicines, rivaroxaban can cause side effects, although not everyone gets them.
Common side effect:
- tiredness and lack of energy
- noticeable heartbeats
- feeling dizzy or lightheaded
- feeling or being sick
- shortness of breath
- pale skin
- mild rash
Serious side effect:
- serious allergic reaction
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