This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages without signing in

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.

Create an account to add page annotations

Annotations allow you to add information to this page that would be handy to have on hand during a consultation. E.g. a website or number. This information will always show when you visit this page.

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Connect

Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.