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Rivaroxaban

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Rivaroxaban

Consult the SPC before prescribing this drug.

Rivaroxaban is an anti-Xa inhibitor and is available in 2.5mg, 10mg, 15mg and 20mg tablets.

Indications (1,2)

Rivaroxaban is indicated for:

  • Prophylaxis of venous thromboembolism following knee replacement surgery
  • Prophylaxis of venous thromboembolism following hip replacement surgery
  • Treatment of deep-vein thrombosis or pulmonary embolism
  • Prophylaxis of recurrent deep-vein thrombosis and pulmonary embolism
  • Prophylaxis of stroke and systemic embolism in non-valvular atrial fibrillation
  • Prophylaxis of atherothrombotic events in acute coronary syndrome (with aspirin alone or aspirin and clopidogrel)

Initiation

  • Baseline Activated Partial Prothrombin Time (aPTT), International Normalised Ratio(INR), haemoglobin, urea & electrolytes and liver function tests
  • Weigh patient and obtain height
  • Calculate baseline creatinine clearance (CrCl)
  • If switching from another anticoagulant to rivaroxaban:
    • Parenteral anticoagulants to rivaroxaban - Rivaroxaban should be started 0 to 2 hours before the time of the next scheduled administration of the parenteral medicinal product (e.g. LMWH) or at the time of discontinuation of a continuously administered parenteral medicinal product (e.g. intravenous unfractionated heparin)
    • Vitamin K antagonists to rivaroxaban VKA treatment should be stopped and rivaroxaban therapy should be initiated when the INR is <=3.0

Contra-indications (1,2)

  • Active bleeding; significant risk of major bleeding (e.g. recent gastro-intestinal ulcer, oesophageal varices, recent brain, spine, or ophthalmic surgery, recent intracranial haemorrhage, malignant neoplasms, vascular aneurysm); in acute coronary syndrome - previous stroke or transient ischaemic attack

Dosing advice for Rivaroxaban (3)

 

 

MHRA has received a small number of reports suggesting lack of efficacy (thromboembolic events) in patients taking 15 mg or 20 mg rivaroxaban on an empty stomach; remind patients to take 15 mg or 20 mg rivaroxaban tablets with food (4)

Reference:

  • Wirral University Teaching Hospital NHS Trust. Oral Anticoagulants (VKA and DOAC) Guidelines for prescribing, monitoring and management (Accessed 23/4/19)
  • NHS Specialist Pharmacy Service (October 2017). Suggestions for Drug Monitoring in Adults in Primary Care
  • West Cheshire Commissioning Group (April 24th 2019). Prescribing Guidance for Rivaroxaban.
  • MRHA (July 2019).Drug Safety Update.

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