Believe It or Clot: Rivaroxaban in Preventing Thrombosis in Anti-Phospholipid Syndrome and in Cancer


Christopher Guiliano, clinical pharmacist, is back on The Rounds Table with Carrie Hartner, clinical pharmacist in the medical intensive care unit.  Together they cover rivaroxaban in preventing thrombosis in patients with Anti-phospholipid syndrome (APS) and in patients with cancer.

The prevalence of APS is 50 in 100,000 patients and it is associated with arterial and venous thromboembolic events and pregnancy morbidity.  There is limited research evaluating rivaroxaban in APS.  Chris reviews a randomized control trial on patients with APS receiving rivaroxaban or warfarin and compares the rate of thromboembolic and bleeding events.

The standard of care for venous thromboembolism (VTE) in patients with active cancer is low molecular weight heparin. Recent research has surfaced to evaluate the direct oral anticoagulants (DOACs) in this population.  Carrie walks listeners through a randomized open-label trial of patients with active VTE receiving either dalteparin or rivaroxaban. Outcomes were compared including VTE recurrence, major bleeding, and clinically relevant non-major bleeding.

Finally, the Good Stuff segment.  Chris shares The Human Diagnosis Project, a website in which medical professionals share cases for their colleagues to solve.  Carrie discusses an opinion piece reflecting on a recent study that showed that 60% of Clostridium difficile spores were left on hospital bedsheets after laundering, a figure that may explain previously unaccounted for hospital outbreaks.

Like what you hear?  Rate us on iTunes!  Chat with us on Twitter at @roundstable and tweet at Chris Guiliano @ChristopherGiu9.

Interested in helping us evaluate our podcast episodes? We’re currently recruiting a panel of residents to serve as regular reviewers for the show. If you’re interested, email wkwong@qmed.ca.

The Papers

1. APS: https://www.ncbi.nlm.nih.gov/pubmed/30002145

2. SELECT-D: http://ascopubs.org/doi/full/10.1200/JCO.2018.78.8034?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed

Good Stuff

1. The Human Diagnosis Project: https://www.humandx.org

2. C. diff Spores: https://www.medscape.com/viewarticle/903601

Music Credits

The Rounds Table Theme Music by Brendan Quinn, Creative Director and Composer, Vapor RMW

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