Rivaroxaban: Difference between revisions

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==Administration==
==Administration==
*Type: Anticoagulant, Factor Xa Inhibitor
*Type: [[Anticoagulant]], Factor Xa Inhibitor
*Dosage Forms: 10, 15, 20
*Dosage Forms: 10mg, 15mg, 20mg
*Routes of Administration:
*Routes of Administration:
*Common Trade Names: Xarelto
*Common Trade Names: Xarelto


==Adult Dosing==
==Adult Dosing==
*Thromboembolism/[[stroke]] prophylaxis: 20 mg PO qd
*Thromboembolism/[[stroke]] prophylaxis: 20mg PO QD
*[[DVT]] Prophylaxis: 10 mg PO qd x35 days; Start: 6-10h post-op once hemostasis established
*[[DVT]] Prophylaxis: 10mg PO QD x35 days; Start: 6-10h post-op once hemostasis established
*[[DVT]]/[[PE]] Prophylaxis, recurrent: 20 mg PO qd
*[[DVT]]/[[PE]] Prophylaxis, recurrent: 20mg PO QD
*[[DVT]]/[[PE]] Treatment: 20 mg PO qd
*[[DVT]]/[[PE]] Treatment: 20mg PO QD
*[[Atrial fibrillation]] and new stent<ref>Gibson CM et al. Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI. N Engl J Med 2016 Nov 14.</ref>:
**Rivaroxaban 15 mg/day plus [[clopidogrel]] for 12 months post-stenting just as efficacious to current standard
**Reduces clinically significant bleeds from ~27% to 17% as compared to [[warfarin]] plus DAPT


==Special Populations==
==Special Populations==
*Pregnancy Risk Factor: C
*[[Drug ratings in pregnancy|Pregnancy Risk Factor]]: C


===Renal Dosing===
===Renal Dosing===
*Thromboembolism/stroke prophylaxis
*Thromboembolism/[[stroke]] prophylaxis
**CrCl 15-50: 15 mg qd; CrCl <15: avoid use
**CrCl 15-50: 15mg QD; CrCl <15: avoid use
*DVT prophylaxis
*[[DVT]] prophylaxis
**CrCl 30-50: caution advised; CrCl <30: avoid use
**CrCl 30-50: caution advised; CrCl <30: avoid use
*DVT/PE prophylaxis, recurrent
*[[DVT]]/[[PE]] prophylaxis, recurrent
**CrCl <30: avoid use
**CrCl <30: avoid use
*DVT/PE tx
*[[DVT]]/[[PE]] treatment
**CrCl <30: avoid use
**CrCl <30: avoid use


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*Hepatic impairment, Child-Pugh Class B or C
*Hepatic impairment, Child-Pugh Class B or C
*Coagulopathy-assoc. hepatic disease
*Coagulopathy-assoc. hepatic disease
*CrCl <30 (DVT prophylaxis, recurrent DVT/PE prophylaxis, DVT/PE tx use)
*CrCl <30 (DVT prophylaxis, recurrent DVT/PE prophylaxis, DVT/PE treatment use)
*CrCl <15 (thromboembolism/stroke prophylaxis use)
*CrCl <15 (thromboembolism/stroke prophylaxis use)
*Acute [[PE]] with hemodynamic instability
*Acute [[PE]] with hemodynamic instability
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==Adverse Reactions==
==Adverse Reactions==
===Serious===
===Serious===
*Bleeding, severe
*[[Anticoagulant reversal for life-threatening bleeds|Bleeding, severe]]
*Epidural/spinal hematoma
**[[Andexanet alfa]]
*Thrombocytopenia
*Epidural/[[spinal hematoma]]
*[[Thrombocytopenia]]
*Agranulocytosis
*Agranulocytosis
*Hypersensitivity rxn
*Hypersensitivity reaction
*Stevens-Johnson syndrome
*[[Stevens-Johnson syndrome]]
*Hepatitis
*[[Hepatitis]]
 
===Common===
===Common===
*Bleeding
*Bleeding
*Back pain
*[[Back pain]]
*Pruritus
*[[Pruritus]]
*Elevated ALT  
*Elevated ALT  
*Thrombocytopenia
*[[Thrombocytopenia]]
*Decreased platelets


==Pharmacology==
==Pharmacology==
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*Inhibits platelet activation and fibrin clot formation via direct, selective and reversible inhibition of factor Xa in both the intrinsic and extrinsic coagulation pathways  
*Inhibits platelet activation and fibrin clot formation via direct, selective and reversible inhibition of factor Xa in both the intrinsic and extrinsic coagulation pathways  


==See Also==
*[[Anticoagulant reversal for life-threatening bleeds]]
*[[Andexanet alfa]]


==References==
==References==
<UpToDate, Epocrates>
*UpToDate
*Epocrates
<references/>
[[Category:Pharmacology]]
[[Category:Pharmacology]]

Revision as of 16:11, 8 March 2021

Administration

  • Type: Anticoagulant, Factor Xa Inhibitor
  • Dosage Forms: 10mg, 15mg, 20mg
  • Routes of Administration:
  • Common Trade Names: Xarelto

Adult Dosing

  • Thromboembolism/stroke prophylaxis: 20mg PO QD
  • DVT Prophylaxis: 10mg PO QD x35 days; Start: 6-10h post-op once hemostasis established
  • DVT/PE Prophylaxis, recurrent: 20mg PO QD
  • DVT/PE Treatment: 20mg PO QD
  • Atrial fibrillation and new stent[1]:
    • Rivaroxaban 15 mg/day plus clopidogrel for 12 months post-stenting just as efficacious to current standard
    • Reduces clinically significant bleeds from ~27% to 17% as compared to warfarin plus DAPT

Special Populations

Renal Dosing

  • Thromboembolism/stroke prophylaxis
    • CrCl 15-50: 15mg QD; CrCl <15: avoid use
  • DVT prophylaxis
    • CrCl 30-50: caution advised; CrCl <30: avoid use
  • DVT/PE prophylaxis, recurrent
    • CrCl <30: avoid use
  • DVT/PE treatment
    • CrCl <30: avoid use

Hepatic Dosing

  • Avoid Use In:
    • Child-Pugh Class B or C
    • Coagulopathy-assoc. hepatic disease

Contraindications

  • Active major bleeding
  • Hepatic impairment, Child-Pugh Class B or C
  • Coagulopathy-assoc. hepatic disease
  • CrCl <30 (DVT prophylaxis, recurrent DVT/PE prophylaxis, DVT/PE treatment use)
  • CrCl <15 (thromboembolism/stroke prophylaxis use)
  • Acute PE with hemodynamic instability
  • Acute PE requiring thrombolysis or pulmonary embolectomy

Adverse Reactions

Serious

Common

Pharmacology

  • Half-life: 5-9 hours
  • Metabolism: CYP450
  • Excretion: 66% Urine, 28% Feces

Mechanism of Action

  • Inhibits platelet activation and fibrin clot formation via direct, selective and reversible inhibition of factor Xa in both the intrinsic and extrinsic coagulation pathways

See Also

References

  • UpToDate
  • Epocrates
  1. Gibson CM et al. Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI. N Engl J Med 2016 Nov 14.