Rivaroxaban

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:
  • 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

• Pregnancy Risk Factor: C

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

See Also

• Anticoagulant reversal for life-threatening bleeds

References

• UpToDate
• Epocrates

Authors

Kristina Shigyo, Kevin Lu, Ross Donaldson, Daniel Ostermayer, Neil Young