Background: The direct factor Xa inhibitor rivaroxaban is approved for the treatment of venous thromboembolism (VTE), based on the results of large phase III trials. Objectives: To confirm rivaroxaban's effectiveness and safety in routine clinical care of patients with VTE. Methods: Data were obtained from prospective, noninterventional registries: the FIRST registry (United Kingdom), DRESDEN NOAC registry (Germany), and SWIVTER (Switzerland). Baseline characteristics of these registries and effectiveness and safety outcome rates for the FIRST and DRESDEN NOAC registries were compared. Results: A total of 1841 rivaroxaban-treated patients with acute VTE (57.9% male, 76.6% deep vein thrombosis [DVT]; 23.4% pulmonary embolism ± DVT; median age, 61 years) were included: 1217 from the FIRST registry, 418 from the DRESDEN NOAC registry, and 206 from SWIVTER. Median time between VTE diagnosis and initiation of rivaroxaban was 1.4 ± 1.81 days (25th–75th percentile 1–1; range, 0–15 days). On-treatment outcome rates for the FIRST and DRESDEN NOAC registries were 0.74 per 100 patient-years (95% confidence interval [CI], 0.35–1.54) versus 0.96 per 100 patient-years (95% CI, 0.46–2.01) for VTE recurrence; 1.16 per 100 patient years (95% CI, 0.64–2.09) versus 2.51 per 100 patient-years (95% CI, 1.58–3.98) for ISTH major bleeding and 1.69 per 100 patient-years (95% CI, 1.21–2.35) versus 1.73 per 100 patient-years (95% CI, 1.27–2.36) for all-cause mortality (intention-to-treat analysis), respectively. Conclusion: Overall treatment outcomes were consistent with the results of the phase III rivaroxaban trials in VTE treatment, indicating that the use of rivaroxaban offers acceptable treatment results also in routine care. However, we observed significant differences in patient characteristics and management patterns across Switzerland, the United Kingdom, and Germany, limiting direct comparisons of unadjusted outcome event rates between registries.

Submitted by Hellen Luz (hellencrisluz@gmail.com) on 2017-07-24T16:22:21Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_PerfilMolecularGenes.pdf: 1048037 bytes, checksum: d0479df3122ed434a7a26c2cbc4534bf (MD5) / Approved for entry into archive by Irvana Coutinho (irvana@ufpa.br) on 2017-07-25T13:09:26Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_PerfilMolecularGenes.pdf: 1048037 bytes, checksum: d0479df3122ed434a7a26c2cbc4534bf (MD5) / Made available in DSpace on 2017-07-25T13:09:26Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_PerfilMolecularGenes.pdf: 1048037 bytes, checksum: d0479df3122ed434a7a26c2cbc4534bf (MD5) Previous issue date: 2014-01-23 / Nos últimos anos, novos anticoagulantes têm sido desenvolvidos com o objetivo de minimizar as dificuldades encontradas no manejo clínico das drogas convencionais, porém não existem dados publicados sobre a sua farmacogenética. Diante da hipótese de que os polimorfismos relacionados à sua metabolização possam ser fonte de variabilidade genética, o presente estudo objetiva realizar inferências de epidemiologia molecular dos polimorfismos nos genes CyP3a4 (rs2246709) e CyP2j2 (rs890293), relacionados ao metabolismo do Rivaroxaban, um novo inibidor direto do fator Xa. São analisadas 136 amostras de indivíduos saudáveis de uma população do Norte do Brasil que apresenta um elevado grau de mistura interétnica. Para alcançar o objetivo farmacogenético foi realizada, em paralelo, análise de ancestralidade genômica nos indivíduos investigados. Os resultados demonstraram diferenças significativas entre os genótipos do CyP3a4 observados no estudo, quando comparados a todas as populações ancestrais para o polimorfismo 99365719 a>G (P<0,05). a população miscigenada do Norte do Brasil, portanto, apresentou diferença na distribuição das frequências genotípicas em relação aos grupos ancestrais, formadores de nossa população. O mesmo achado não é observado para polimorfismo do gene do CyP2j2. Destaca-se que o polimorfismo no gene do CyP3a4, na amostra investigada, sofre influência da contribuição étnica européia individual. Considerando, a elevada miscigenação que caracteriza a população local e o avanço da Farmacogenômica na medicina atual, os dados podem contribuir para a melhor compreensão da farmacogenética do novo anticoagulante. / In recent years, new anticoagulants have been developed with the purpose of minimizing the difficulties encountered in the clinical management of conventional dru- gs, but there are no published data on its pharmacogenetics. Considering the hypothe- sis that polymorphisms related to its metabolism may be the source of genetic variability, this study aims to make inferences on molecular epidemiology of polymorphisms in CyP3a4 (rs2246709) and CyP2j2 (rs890293) genes related to the metabolism of Rivaroxaban, a new direct factor Xa inhibitor. 136 samples from healthy individuals in a population of northern Brazil with a high degree of inter-ethnic mix, so as to guarantee that the pharmacogenetic goal was achieved, have been subjected to a parallel analysis of genomic ancestry for the individuals investigated. The results sho- wed significant differences among genotypes for CyP3a4 observed in the study com- pared to all ancestral populations for a polymorphism 99,365,719 a> G ( P < 0.05). The mixed population of northern Brazil, therefore, showed differences in the distribution of genotype frequencies in relation to ancestral groups, forming our population. The same finding was not observed for the CyP2j2 gene polymorphism. It is noteworthy that the polymorphism in the CyP3a4 gene in the investigated sample is influenced by indivi- dual ethnic European contribution. Considering the high miscegenation featuring local people, and the advancement of Pharmacogenomics in current medicine, such data can contribute to a better understanding of the pharmacogenetics of that new anticoagulant.

No description available.

Postthrombotic syndrome (PTS) is a frequent complication of venous thromboembolism (VTE). Using MarketScan claims data from January 2012 to June 2015, we identified adults with a primary diagnosis code for VTE during a hospitalization/emergency department visit, ≥6 months of insurance coverage prior to the index event and newly started on rivaroxaban or warfarin within 30 days of the index VTE. Patients with <4-month follow-up postindex event or a claim for any anticoagulant during 6-month baseline period were excluded. Differences in baseline characteristics between rivaroxaban and warfarin users were adjusted for using inverse probability of treatment weights based on propensity scores. Patients were followed for the development of PTS starting 3 months after the index VTE. Cox regression was performed and reported as hazard ratios with 95% confidence intervals (CIs). In total, 10 463 rivaroxaban and 26 494 warfarin users were followed for a mean of 16 ± 9 (range, 4-39) months. Duration of anticoagulation was similar between cohorts (median = 6 months). Rivaroxaban was associated with a 23% (95% CI: 16-30) reduced hazard of PTS versus warfarin. Rivaroxaban was associated with a significant risk reduction in symptoms of PTS compared to warfarin in patients with VTE treated in routine practice.

Depuis déjà quelques années au Canada, l’arrivée progressive de nouveaux anticoagulants oraux (NACO) propose des options dans le traitement de la thromboembolie veineuse (TEV). Le rivaroxaban, le premier NACO approuvé pour cette indication, possède des caractéristiques différentes des antagonistes de la vitamine K (AVK), les seuls agents anticoagulants oraux disponibles jusqu’à ce jour. Dans la littérature scientifique actuelle, peu de données sont disponibles sur le rivaroxaban et aucune étude n’a été identifiée concernant l’usage de ce médicament en contexte réel de soins de santé. Or, les objectifs de cette étude étaient de décrire le portrait de l’usage des anticoagulants pour le traitement initial et subséquent de la TEV au CHUS depuis l’introduction du rivaroxaban au formulaire thérapeutique de cet établissement et dans un deuxième temps, à identifier les facteurs associés au choix de l’anticoagulant oral prescrit pour le traitement subséquent de la TEV. Pour ce faire, une étude transversale a été réalisée. Les patients qui ont visité l’urgence ou qui ont été hospitalisés au CHUS entre le 18 février 2013 et le 18 septembre 2013 pour une thrombose veineuse profonde (TVP) et/ou une embolie pulmonaire (EP) ont été inclus. Les patients devaient toutefois nouvellement débuter un traitement anticoagulant durant le séjour, et ce dernier devait être poursuivi au congé de l’hôpital. Les anticoagulants prescrits pour le traitement initial et subséquent de la TEV ont été décrits. Les facteurs potentiels du choix ont d’abord été évalués à l’aide d’analyses bivariées et par la suite, une régression logistique multiple utilisant une méthode ascendante a été utilisée afin d’identifier les facteurs indépendamment associés au choix du rivaroxaban plutôt que de la warfarine (seul AVK disponible au CHUS). Ainsi, sur une période de 7 mois, 256 patients ont été inclus dans l’étude. Le traitement initial et le traitement subséquent les plus prescrits correspondaient respectivement, à l’héparine de bas poids moléculaire (HBPM; 61,7 %) et à la warfarine (54,7 %). Le rivaroxaban était peu utilisé en phase initiale de traitement (1,6 %) alors qu’il a été prescrit chez près de 20 % des individus au congé de l’hôpital pour le traitement subséquent de la TEV. Les facteurs indépendamment associés à la prescription de rivaroxaban plutôt que de warfarine étaient l’âge ˂ 65 ans (Rapport de cotes [RC] ajusté 2,86; Intervalle de confiance [IC] à 95 % 1,29–6,37), un diagnostic de TVP seule plutôt qu’une EP (RC ajusté 2,54; IC à 95 % 1,20–5,40) et une visite à l’urgence sans hospitalisation (RC ajusté 2,24; IC à 95 % 1,06–4,71). En conclusion, parmi les nouveaux utilisateurs d’anticoagulants pour le traitement de la TEV au CHUS, la thérapie conventionnelle (HBPM suivie d’un AVK) était la plus prescrite par les médecins malgré l’arrivée d’une nouvelle option pharmacologique de traitement. De plus, les jeunes patients, les individus qui avaient une TVP sans EP et ceux qui n’étaient pas hospitalisés étaient plus susceptibles de recevoir le rivaroxaban pour le traitement subséquent de la TEV.

Chez le chien, les thromboses représentent une complication majeure de nombreuses conditions qui sont revues dans ce manuscrit. L’arsenal thérapeutique actuel présente certaines limites: des effets anticoagulants variables d’un patient à l’autre, des hémorragies et une administration par voie sous-cutanée pour l’héparine. Le rivaroxaban est un nouvel anticoagulant oral approuvé pour la prévention et le traitement des thromboses chez l’humain. C’est un inhibiteur direct du facteur Xa. La présente étude a pour objectif d’évaluer les effets hémostatiques du rivaroxaban chez des chiens en santé, en utilisant les tests de coagulation suivants: temps de prothrombine (PT), temps partiel de thromboplastine (aPTT), activité anti-facteur X, génération de thrombine (GT) et thromboélastographie (TEG®). Tout d’abord, l’effet anticoagulant du rivaroxaban a été évalué in vitro : le plasma citraté pauvre en plaquettes provenant de 20 Beagle en santé a été aliquoté et enrichi avec des solutions de rivaroxaban à des concentrations de 0 à 1000 mg/L d’anticoagulant. Une prolongation concentration-dépendante de tous les tests de coagulation a été notée. Les concentrations de 0.024 et 0.053 mg/L diminuent respectivement de 50% la vitesse de propagation de la GT et la densité optique de l’activité anti-facteur X. Ces derniers tests sont les plus sensibles et précis pour détecter l’effet anticoagulant du rivaroxaban. Ensuite, 24 Beagle en santé ont été répartis aléatoirement en 3 groupes (n=8). Chaque groupe a reçu par voie orale un placebo, ou 20 mg de rivaroxaban une ou deux fois à 8h d’intervalle. Quinze échantillons sanguins ont été prélevés pour chaque chien sur 30 heures. Pour tous les tests de coagulation excepté la TEG®, une différence significative a été notée dans les résultats entre les groupes traités et le groupe placebo (p<0.0001). La durée de l’effet anticoagulant du rivaroxaban était de 7.9-18.7h dans le groupe traité une fois; et de 17.5-26.8h dans le groupe traité deux fois. Le pic d’action de l’effet anticoagulant était d’environ 2h. Seul le paramètre R de la TEG® était significativement affecté dans les groupes traités. En conclusion, le rivaroxaban exerce un effet anticoagulant chez le chien à la dose de 2 mg/kg. Une administration biquotidienne semble appropriée pour un effet de 24h. / In dogs, thrombosis is a major complication detected in many conditions. The limits of the current available anticoagulants in veterinary medicine are their variable effects from one patient to another, bleeding complications and subcutaneous injections for heparin administration. Rivaroxaban is a novel oral anticoagulant approved for the prevention and treatment of thrombosis in humans. It is a direct factor Xa inhibitor. The objectives of the study were to determine the haemostatic effects of rivaroxaban in healthy dogs by evaluating the following coagulation assays: prothrombin time (PT), activated partial thromboplastin time (aPTT), anti-factor X activity, thrombin generation (TG) and thromboelastography (TEG®). An in vitro study was conducted: citrated platelet poor plasma from 20 healthy Beagles was aliquoted and mixed with rivaroxaban to obtain solutions ranging from 0 to 1000 mg/L of the anticoagulant. Rivaroxaban exerted a concentration-dependent anticoagulant effect. Rivaroxaban solutions at 0.024 and 0.053 mg/L cause 50% inhibition of the propagation of TG and of the optical density of anti-factor X activity respectively. These assays were the most sensitive to detect the anticoagulant effect of rivaroxaban. Secondly, 24 healthy Beagles were randomly divided in 3 groups (n=8) and received one placebo pill orally, or 20 mg rivaroxaban once or twice at 8h interval. Fifteen citrated blood samples were collected from each dog over 30h. For each coagulation assay except for TEG®, there was a significant difference in assay results between placebo and rivaroxaban groups (p<0.0001). The duration of the rivaroxaban anticoagulant effect was 7.9-18.7h in the group receiving rivaroxaban once, and 17.5-26.8h in the group receiving rivaroxaban twice. The peak of action of rivaroxaban appeared 2h after the dose. Only R parameter of TEG® was significantly affected by rivaroxaban administration. To conclude, rivaroxaban is an efficient anticoagulant in healthy dogs at 2 mg/kg. A twice daily administration seems appropriate to exert a 24h anticoagulation.

A análise de fármacos é fundamental nas diversas fases do desenvolvimento farmacêutico, tais como estudos de formulação, estabilidade e controle de qualidade do produto. A rivaroxabana (RIV) é um anticoagulante de uso oral indicado para prevenção da formação de coágulos venosos. A literatura pesquisada apresenta poucos relatos de determinação quantitativa e de estudos de estabilidade do fármaco em comprimidos. E ainda nenhum método analítico em compêndios oficiais Diante do exposto, o objetivo deste trabalho foi desenvolver e validar métodos analíticos para determinação qualitativa e quantitativa da RIV por cromatografia líquida de alta eficiência com detecção por UV e de ultra eficiência com detecção por espectrometria de massas (CLAE-UV e CLUE-EM) e eletroforese capilar (EC). Os resultados encontrados foram adequados conforme o preconizado nos guias oficiais nacionais e internacionais. Foi avaliada também a viabilidade da técnica de eletroforese capilar em microchip para análise de RIV. Através de método desenvolvido por CLAE foi realizado estudo de cinética de degradação e posterior avaliação do potencial tóxico in vitro das amostras de degradação forçada da RIV. A identificação de três produtos de degradação majoritários da RIV, formados a partir de estresse ácido, alcalino e fotolítico, foi realizada por CLUE-EM/EM, possibilitando a proposição da estrutura molecular de cada produto de degradação. O potencial tóxico da RIV antes e depois da exposição à degradação forçada foi avaliado através dos métodos in vitro MTT, Vermelho Neutro, Ensaio Cometa e DNA de baixo peso molecular. Não foram encontrados sinais de dano ao DNA celular, contudo, amostras de RIV expostas ao meio alcalino apresentaram maior redução da viabilidade celular. O trabalho avaliou ainda o perfil de dissolução da RIV em comprimidos baseado nos dados de absorção in vitro conforme modelagem in silico dos dados, estabelecendo uma correlação linear entre a fração absorvida e fração dissolvida. As diferentes metodologias e técnicas desenvolvidas e aplicadas nesse trabalho contribuem para o desenvolvimento do controle de qualidade farmacêutico na direção de ensaios mais confiáveis que garantam a segurança e eficácia de medicamentos. / Drug analysis is critical at various stages of pharmaceutical development, such as formulation studies, stability and quality control products. Rivaroxaban (RIV) is an oral anticoagulant indicated for prevention of thromboembolism. Literature contains few reports of quantitative determination and drug stability studies of RIV on pharmaceutical formulation. Analytical method for RIV quality control are not evaluable on official guides yet. This research work aimed to develop and validate analytical methods for qualitative and quantitative determination of RIV by high and ultra performance liquid chromatography with UV detection mass spectrometry detection (HPLC -UV and UPLC-MS) and capillary electrophoresis (CE). The results were adequate as recommended in national and international official guides. Reliability of RIV analysis by microchip capillary electrophoresis was also assessed. Through the method developed by HPLC degradation kinetic studies were performed, zero order kinetic has better description of RIV degradation behaviour. RIV toxic potential before and after exposure to forced degradation was assessed by in vitro methods of MTT, Neutral Red, Comet Assay, and Low Molecular Weight DNA. There were no signals of DNA damage however, RIV samples exposed to alkaline medium showed increased reduction in cell viability. Identification of RIV degradation products formed after exposure to acid and alkaline media and UVC radiation was performed by UPLC-MS / MS. It was possible to elucidate molecular structures of three major degradation products. This study also assessed the dissolution profile of RIV tablets based on in vitro absorption data, a linear point-to-point correlation was found for fraction absorbed and dissolved. Different methodologies and techniques developed and applied in this work can contribute to the development of pharmaceutical quality towards more reliable tests to ensure safety and efficacy of medicines.

A análise de fármacos é fundamental nas diversas fases do desenvolvimento farmacêutico, tais como estudos de formulação, estabilidade e controle de qualidade do produto. A rivaroxabana (RIV) é um anticoagulante de uso oral indicado para prevenção da formação de coágulos venosos. A literatura pesquisada apresenta poucos relatos de determinação quantitativa e de estudos de estabilidade do fármaco em comprimidos. E ainda nenhum método analítico em compêndios oficiais Diante do exposto, o objetivo deste trabalho foi desenvolver e validar métodos analíticos para determinação qualitativa e quantitativa da RIV por cromatografia líquida de alta eficiência com detecção por UV e de ultra eficiência com detecção por espectrometria de massas (CLAE-UV e CLUE-EM) e eletroforese capilar (EC). Os resultados encontrados foram adequados conforme o preconizado nos guias oficiais nacionais e internacionais. Foi avaliada também a viabilidade da técnica de eletroforese capilar em microchip para análise de RIV. Através de método desenvolvido por CLAE foi realizado estudo de cinética de degradação e posterior avaliação do potencial tóxico in vitro das amostras de degradação forçada da RIV. A identificação de três produtos de degradação majoritários da RIV, formados a partir de estresse ácido, alcalino e fotolítico, foi realizada por CLUE-EM/EM, possibilitando a proposição da estrutura molecular de cada produto de degradação. O potencial tóxico da RIV antes e depois da exposição à degradação forçada foi avaliado através dos métodos in vitro MTT, Vermelho Neutro, Ensaio Cometa e DNA de baixo peso molecular. Não foram encontrados sinais de dano ao DNA celular, contudo, amostras de RIV expostas ao meio alcalino apresentaram maior redução da viabilidade celular. O trabalho avaliou ainda o perfil de dissolução da RIV em comprimidos baseado nos dados de absorção in vitro conforme modelagem in silico dos dados, estabelecendo uma correlação linear entre a fração absorvida e fração dissolvida. As diferentes metodologias e técnicas desenvolvidas e aplicadas nesse trabalho contribuem para o desenvolvimento do controle de qualidade farmacêutico na direção de ensaios mais confiáveis que garantam a segurança e eficácia de medicamentos. / Drug analysis is critical at various stages of pharmaceutical development, such as formulation studies, stability and quality control products. Rivaroxaban (RIV) is an oral anticoagulant indicated for prevention of thromboembolism. Literature contains few reports of quantitative determination and drug stability studies of RIV on pharmaceutical formulation. Analytical method for RIV quality control are not evaluable on official guides yet. This research work aimed to develop and validate analytical methods for qualitative and quantitative determination of RIV by high and ultra performance liquid chromatography with UV detection mass spectrometry detection (HPLC -UV and UPLC-MS) and capillary electrophoresis (CE). The results were adequate as recommended in national and international official guides. Reliability of RIV analysis by microchip capillary electrophoresis was also assessed. Through the method developed by HPLC degradation kinetic studies were performed, zero order kinetic has better description of RIV degradation behaviour. RIV toxic potential before and after exposure to forced degradation was assessed by in vitro methods of MTT, Neutral Red, Comet Assay, and Low Molecular Weight DNA. There were no signals of DNA damage however, RIV samples exposed to alkaline medium showed increased reduction in cell viability. Identification of RIV degradation products formed after exposure to acid and alkaline media and UVC radiation was performed by UPLC-MS / MS. It was possible to elucidate molecular structures of three major degradation products. This study also assessed the dissolution profile of RIV tablets based on in vitro absorption data, a linear point-to-point correlation was found for fraction absorbed and dissolved. Different methodologies and techniques developed and applied in this work can contribute to the development of pharmaceutical quality towards more reliable tests to ensure safety and efficacy of medicines.

A análise de fármacos é fundamental nas diversas fases do desenvolvimento farmacêutico, tais como estudos de formulação, estabilidade e controle de qualidade do produto. A rivaroxabana (RIV) é um anticoagulante de uso oral indicado para prevenção da formação de coágulos venosos. A literatura pesquisada apresenta poucos relatos de determinação quantitativa e de estudos de estabilidade do fármaco em comprimidos. E ainda nenhum método analítico em compêndios oficiais Diante do exposto, o objetivo deste trabalho foi desenvolver e validar métodos analíticos para determinação qualitativa e quantitativa da RIV por cromatografia líquida de alta eficiência com detecção por UV e de ultra eficiência com detecção por espectrometria de massas (CLAE-UV e CLUE-EM) e eletroforese capilar (EC). Os resultados encontrados foram adequados conforme o preconizado nos guias oficiais nacionais e internacionais. Foi avaliada também a viabilidade da técnica de eletroforese capilar em microchip para análise de RIV. Através de método desenvolvido por CLAE foi realizado estudo de cinética de degradação e posterior avaliação do potencial tóxico in vitro das amostras de degradação forçada da RIV. A identificação de três produtos de degradação majoritários da RIV, formados a partir de estresse ácido, alcalino e fotolítico, foi realizada por CLUE-EM/EM, possibilitando a proposição da estrutura molecular de cada produto de degradação. O potencial tóxico da RIV antes e depois da exposição à degradação forçada foi avaliado através dos métodos in vitro MTT, Vermelho Neutro, Ensaio Cometa e DNA de baixo peso molecular. Não foram encontrados sinais de dano ao DNA celular, contudo, amostras de RIV expostas ao meio alcalino apresentaram maior redução da viabilidade celular. O trabalho avaliou ainda o perfil de dissolução da RIV em comprimidos baseado nos dados de absorção in vitro conforme modelagem in silico dos dados, estabelecendo uma correlação linear entre a fração absorvida e fração dissolvida. As diferentes metodologias e técnicas desenvolvidas e aplicadas nesse trabalho contribuem para o desenvolvimento do controle de qualidade farmacêutico na direção de ensaios mais confiáveis que garantam a segurança e eficácia de medicamentos. / Drug analysis is critical at various stages of pharmaceutical development, such as formulation studies, stability and quality control products. Rivaroxaban (RIV) is an oral anticoagulant indicated for prevention of thromboembolism. Literature contains few reports of quantitative determination and drug stability studies of RIV on pharmaceutical formulation. Analytical method for RIV quality control are not evaluable on official guides yet. This research work aimed to develop and validate analytical methods for qualitative and quantitative determination of RIV by high and ultra performance liquid chromatography with UV detection mass spectrometry detection (HPLC -UV and UPLC-MS) and capillary electrophoresis (CE). The results were adequate as recommended in national and international official guides. Reliability of RIV analysis by microchip capillary electrophoresis was also assessed. Through the method developed by HPLC degradation kinetic studies were performed, zero order kinetic has better description of RIV degradation behaviour. RIV toxic potential before and after exposure to forced degradation was assessed by in vitro methods of MTT, Neutral Red, Comet Assay, and Low Molecular Weight DNA. There were no signals of DNA damage however, RIV samples exposed to alkaline medium showed increased reduction in cell viability. Identification of RIV degradation products formed after exposure to acid and alkaline media and UVC radiation was performed by UPLC-MS / MS. It was possible to elucidate molecular structures of three major degradation products. This study also assessed the dissolution profile of RIV tablets based on in vitro absorption data, a linear point-to-point correlation was found for fraction absorbed and dissolved. Different methodologies and techniques developed and applied in this work can contribute to the development of pharmaceutical quality towards more reliable tests to ensure safety and efficacy of medicines.

Study Objective Although data from the Regulation of Coagulation in Orthopedic Surgery to Prevent Deep Venous Thrombosis and Pulmonary Embolism (RECORD) 1-4 trials have shown a similar postoperative bleeding risk between rivaroxban and enoxaparin in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA), anecdotal observations from local institutions have suggested that postoperative bleeding rates seemed higher in patients who received rivaroxaban than those reported in the RECORD trials. Thus, the objective of this pilot study was to assess postoperative bleeding events observed in clinical practice in patients receiving rivaroxaban after undergoing THA and TKA and to compare their results with those published in the RECORD trials. Design Retrospective cohort study with a comparator group of patients from the RECORD 1-4 trials. Setting Two institutions within a regional health care system. Patients Four hundred forty adults who received at least one dose of rivaroxaban 10 mg daily after undergoing THA or TKA in the two institutions between August 2011 and October 2013 (cohort group), and 6183 patients who received rivaroxaban in the RECORD 1-4 trials (comparator group). Measurements and Main Results Postoperative bleeding was assessed in the cohort patients versus the patients in the RECORD trials. The primary outcome, occurrence of any postoperative bleeding, was a composite of major and clinically relevant nonmajor bleeding as defined in the RECORD trials. Any postoperative bleeding occurred in 6.8% of the cohort patients versus 3.2% of the RECORD trial patients (p<0.0001); 1.4% of the cohort patients versus 0.38% of the RECORD trial patients suffered a major bleed (p=0.013). Within defined major bleeding, bleeding leading to reoperation and clinically overt extrasurgical site bleeding resulting in either a hemoglobin level decrease of at least 2 g/dl or transfusion of 2 units or greater of packed red blood cells were reported in 0.68% versus 0.19% (p=0.073) and 0.68% versus 0.13% (p=0.032), respectively, of the cohort patients versus the RECORD trial patients. Conclusion Overall, any postoperative bleeding in the cohort patients occurred significantly more frequently than that observed in the RECORD trial patients. The major bleeding rate was also significantly higher in the cohort patients, influenced by higher rates of bleeding leading to reoperation and clinically overt extrasurgical site bleeding resulting in either a hemoglobin decrease of at least 2 g/dl or transfusion of two units or greater of packed red blood cells. These findings from our pilot study are thought provoking and, thus, invite further investigation.