Vitamin K antagonist anticoagulants, with warfarin being the most common, have been historically prescribed. For patients with diagnosed NVAF, the current ACC/AHA/HRS Guideline for the Management of Patients with AF recommends oral anticoagulation in those with a prior stroke or transient ischemic attack, or those with a moderate or greater risk of stroke (CHA 2DS 2-VASc score ≥1 in males or ≥2 in females). Patients with any type of NVAF, whether permanent, persistent or paroxysmal, and whether they are symptomatic or asymptomatic, are at increased risk of thromboembolic ischemic stroke, with NVAF patients experiencing fivefold higher rates of stroke than those without NVAF. Rivaroxaban has also been approved for the treatment of venous thromboembolism and the prophylaxis of deep venous thrombosis (DVT) following hip or knee replacement surgery, but that will not be the focus of this review. Rivaroxaban is a direct oral anticoagulant (DOAC) approved by the US FDA on 4 November 2011 for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (NVAF).
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