Rivaroxaban
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 once daily
DVT/PE Treatment
- 15mg twice daily x 21 days if CrCl ≥15[1]
- 20mg once daily starting day 22 if CrCl ≥15
Atrial fibrillation and new stent[2]
- 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
- Bleeding, severe
- Epidural/spinal hematoma
- Thrombocytopenia
- Agranulocytosis
- Hypersensitivity reaction
- Stevens-Johnson syndrome
- Hepatitis
Common
- Bleeding
- Back pain
- Pruritus
- Elevated ALT
- Thrombocytopenia
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
Indications by Condition
The following table is automatically generated from disease/condition pages across WikEM.
| Indication | Dose | Context | Route | Population |
|---|---|---|---|---|
| Atrial fibrillation (main) | 20 mg daily with evening meal (reduced: 15 mg daily if CrCl 15-50) | Anticoagulation (NOAC) | PO | Adult |
| Pulmonary embolism | 15 mg PO BID x3 weeks, then 20 mg PO daily | Anticoagulation (DOAC) | PO | Adult |
See Also
References
- UpToDate
- Epocrates
- ↑ Xarelto https://www.xareltohcp.com/dvt-pe/initial/dosing
- ↑ Gibson CM et al. Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI. N Engl J Med 2016 Nov 14.