Direct thrombin inhibitors, but not the direct factor Xa inhibitor rivaroxaban, increase tissue factor-induced hypercoagulability in vitro and in vivo.

Rivaroxaban dose-dependently inhibited the TF-induced increase in TAT levels over a broad dose range (0.001–0.3 mg kg −1 ); the effect was highly significant at doses ≥ 0.03 mg kg −1 ( P < 0.001), with complete inhibition at 0.3 mg kg −1 rivaroxaban (Fig. 5 A).

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However, in all of these trials, rates of MI/acute coronary syndrome (ACS) were low across treatment groups 2 – 8 , and further analysis of data from the Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) study of dabigatran showed that the increase in the occurrence of MI seen with dabigatran did not reach statistical significance 4 .

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