Rivaroxaban

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Administration

  • Type: Anticoagulant, Factor Xa Inhibitor
  • Dosage Forms: 10, 15, 20
  • 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.