Rywaroksaban – lek skuteczny w wielu wskazaniach i różnorodnych grupach pacjentów Artykuł przeglądowy
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Opublikowane:
mar 1, 2026
Słowa kluczowe:
leczenie przeciwkrzepliwe, DOAC, rywaroksaban, migotanie przedsionków, choroba tętnic obwodowych
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Abstrakt
Rywaroksaban, bezpośredni doustny antykoagulant, jest stosowany w prewencji i leczeniu chorób zakrzepowo-zatorowych po epizodzie zakrzepicy żył głębokich i zatorowości płucnej, a także w migotaniu przedsionków oraz przy obecności skrzepliny w lewej komorze. Jest jedynym bezpośrednim doustnym antykoagulantem wskazanym w tzw. dawce naczyniowej w terapii łączonej w przewlekłym zespole wieńcowym i w chorobie tętnic obwodowych, po ostrym zespole wieńcowym oraz po rewaskularyzacji naczyń kończyn dolnych. Jego farmakokinetyka, dawkowanie i profil bezpieczeństwa sprawiają, że jest to lek odpowiedni dla pacjentów starszych i z przewlekłą chorobą nerek. W niniejszym opisie uwzględnione zostało praktyczne spojrzenie neurologa na stosowanie rywaroksabanu w prewencji wtórnej niedokrwiennego udaru mózgu oraz na ryzyko zdarzeń krwotocznych.
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Jak cytować
Skwarek, A., Golenia, A., & Ozierański, K. (2026). Rywaroksaban – lek skuteczny w wielu wskazaniach i różnorodnych grupach pacjentów . Medycyna Faktów , 19(4(69), 535-541. https://doi.org/10.24292/01.MF.0425.08
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Bibliografia
1. Van Gelder IC, Rienstra M, Bunting KV et al.; ESC Scientific Document Group. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2024; 45(36): 3314-414.
2. Steffel J, Collins R, Antz M et al. 2021 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation. Europace. 2021; 23(10): 1612-76.
3. Halperin JL, Hankey GJ, Wojdyla DM et al. Efficacy and safety of rivaroxaban compared with warfarin among elderly patients with nonvalvular atrial fibrillation in the Rivaroxaban Once Daily, Oral, Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF). Circulation. 2014; 130(2): 138-46.
4. Prins MH, Lensing AW, Bauersachs R et al. Oral rivaroxaban versus standard therapy for the treatment of symptomatic venous thromboembolism: a pooled analysis of the EINSTEIN-DVT and PE randomized studies. Thromb J. 2013; 11(1): 21.
5. Burness CB, Perry CM. Rivaroxaban: a review of its use in the treatment of deep vein thrombosis or pulmonary embolism and the prevention of recurrent venous thromboembolism. Drugs. 2014; 74(2): 243-62.
6. Weitz JI, Lensing AWA, Prins MH et al. Rivaroxaban or Aspirin for Extended Treatment of Venous Thromboembolism. N Engl J Med. 2017; 376(13): 1211-22.
7. Shah Jehangir A, Hussain J, Ahmed B et al. Rivaroxaban vs Warfarin in Acute Left Ventricular Thrombus Following Myocardial Infarction. JACC: Advances. 2025; 4(8): 101978.
8. Vrints C, Andreotti F, Koskinas KC et al. 2024 ESC Guidelines for the management of chronic coronary syndromes: Developed by the task force for the management of chronic coronary syndromes of the European Society of Cardiology (ESC) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2024; 45(36): 3415-537.
9. Eikelboom JW, Connolly SJ, Bosch J et al.; COMPASS Investigators. Rivaroxaban with or without Aspirin in Stable Cardiovascular Disease. N Engl J Med. 2017; 377(14): 1319-30.
10. Mazzolai L, Teixido-Tura G, Lanzi S et al. 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases: Developed by the task force on the management of peripheral arterial and aortic diseases of the European Society of Cardiology (ESC) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS), the European Reference Network on Rare Multisystemic Vascular Diseases (VASCERN), and the European Society of Vascular Medicine (ESVM). Eur Heart J. 2024; 45(36): 3538-700.
11. Mega JL, Braunwald E, Wiviott SD et al. Rivaroxaban in Patients with a Recent Acute Coronary Syndrome. N Engl J Med. 2012; 366(1): 9-19.
12. Patel MR, Mahaffey KW, Garg J et al.; ROCKET AF Investigators. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011; 365(10): 883-91.
13. EINSTEIN–PE Investigators; Büller HR, Prins MH, Lensin AW et al. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med. 2012; 366(14): 1287-97.
14. Bonaca MP, Bauersachs RM, Anand SS et al. Rivaroxaban in Peripheral Artery Disease after Revascularization. N Engl J Med. 2020; 382(21): 1994-2004.
15. Gibson CM, Mehran R, Bode C et al. Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI. N Engl J Med. 2016; 375(25): 2423-34.
16. Akao M, Yasuda S, Kaikita K et al. Rivaroxaban monotherapy versus combination therapy according to patient risk of stroke and bleeding in atrial fibrillation and stable coronary disease: AFIRE trial subanalysis. Am Heart J. 2021; 236: 59-68.
17. Summary of product characteristics. Xarelto.
2. Steffel J, Collins R, Antz M et al. 2021 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation. Europace. 2021; 23(10): 1612-76.
3. Halperin JL, Hankey GJ, Wojdyla DM et al. Efficacy and safety of rivaroxaban compared with warfarin among elderly patients with nonvalvular atrial fibrillation in the Rivaroxaban Once Daily, Oral, Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF). Circulation. 2014; 130(2): 138-46.
4. Prins MH, Lensing AW, Bauersachs R et al. Oral rivaroxaban versus standard therapy for the treatment of symptomatic venous thromboembolism: a pooled analysis of the EINSTEIN-DVT and PE randomized studies. Thromb J. 2013; 11(1): 21.
5. Burness CB, Perry CM. Rivaroxaban: a review of its use in the treatment of deep vein thrombosis or pulmonary embolism and the prevention of recurrent venous thromboembolism. Drugs. 2014; 74(2): 243-62.
6. Weitz JI, Lensing AWA, Prins MH et al. Rivaroxaban or Aspirin for Extended Treatment of Venous Thromboembolism. N Engl J Med. 2017; 376(13): 1211-22.
7. Shah Jehangir A, Hussain J, Ahmed B et al. Rivaroxaban vs Warfarin in Acute Left Ventricular Thrombus Following Myocardial Infarction. JACC: Advances. 2025; 4(8): 101978.
8. Vrints C, Andreotti F, Koskinas KC et al. 2024 ESC Guidelines for the management of chronic coronary syndromes: Developed by the task force for the management of chronic coronary syndromes of the European Society of Cardiology (ESC) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2024; 45(36): 3415-537.
9. Eikelboom JW, Connolly SJ, Bosch J et al.; COMPASS Investigators. Rivaroxaban with or without Aspirin in Stable Cardiovascular Disease. N Engl J Med. 2017; 377(14): 1319-30.
10. Mazzolai L, Teixido-Tura G, Lanzi S et al. 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases: Developed by the task force on the management of peripheral arterial and aortic diseases of the European Society of Cardiology (ESC) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS), the European Reference Network on Rare Multisystemic Vascular Diseases (VASCERN), and the European Society of Vascular Medicine (ESVM). Eur Heart J. 2024; 45(36): 3538-700.
11. Mega JL, Braunwald E, Wiviott SD et al. Rivaroxaban in Patients with a Recent Acute Coronary Syndrome. N Engl J Med. 2012; 366(1): 9-19.
12. Patel MR, Mahaffey KW, Garg J et al.; ROCKET AF Investigators. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011; 365(10): 883-91.
13. EINSTEIN–PE Investigators; Büller HR, Prins MH, Lensin AW et al. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med. 2012; 366(14): 1287-97.
14. Bonaca MP, Bauersachs RM, Anand SS et al. Rivaroxaban in Peripheral Artery Disease after Revascularization. N Engl J Med. 2020; 382(21): 1994-2004.
15. Gibson CM, Mehran R, Bode C et al. Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI. N Engl J Med. 2016; 375(25): 2423-34.
16. Akao M, Yasuda S, Kaikita K et al. Rivaroxaban monotherapy versus combination therapy according to patient risk of stroke and bleeding in atrial fibrillation and stable coronary disease: AFIRE trial subanalysis. Am Heart J. 2021; 236: 59-68.
17. Summary of product characteristics. Xarelto.