Rivaroxaban: Difference between revisions
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==Administration== | ==Administration== | ||
*Type: Anticoagulant, Factor Xa Inhibitor | *Type: [[Anticoagulant]], Factor Xa Inhibitor | ||
*Dosage Forms: | *Dosage Forms: 10mg, 15mg, 20mg | ||
*Routes of Administration: | *Routes of Administration: | ||
*Common Trade Names: Xarelto | *Common Trade Names: Xarelto | ||
==Adult Dosing== | ==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<ref>Xarelto https://www.xareltohcp.com/dvt-pe/initial/dosing</ref> | |||
*20mg once daily starting day 22 if CrCl ≥15 | |||
===[[Atrial fibrillation]] and new stent<ref>Gibson CM et al. Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI. N Engl J Med 2016 Nov 14.</ref>=== | |||
*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== | ==Special Populations== | ||
*Pregnancy Risk Factor: C | *[[Drug ratings in pregnancy|Pregnancy Risk Factor]]: C | ||
===Renal Dosing=== | ===Renal Dosing=== | ||
*Thromboembolism/stroke prophylaxis | *Thromboembolism/[[stroke]] prophylaxis | ||
**CrCl 15-50: | **CrCl 15-50: 15mg QD; CrCl <15: avoid use | ||
*DVT prophylaxis | *[[DVT]] prophylaxis | ||
**CrCl 30-50: caution advised; CrCl <30: avoid use | **CrCl 30-50: caution advised; CrCl <30: avoid use | ||
*DVT/PE prophylaxis, recurrent | *[[DVT]]/[[PE]] prophylaxis, recurrent | ||
**CrCl <30: avoid use | **CrCl <30: avoid use | ||
*DVT/PE | *[[DVT]]/[[PE]] treatment | ||
**CrCl <30: avoid use | **CrCl <30: avoid use | ||
| Line 33: | Line 45: | ||
*Hepatic impairment, Child-Pugh Class B or C | *Hepatic impairment, Child-Pugh Class B or C | ||
*Coagulopathy-assoc. hepatic disease | *Coagulopathy-assoc. hepatic disease | ||
*CrCl <30 (DVT prophylaxis, recurrent DVT/PE prophylaxis, DVT/PE | *CrCl <30 (DVT prophylaxis, recurrent DVT/PE prophylaxis, DVT/PE treatment use) | ||
*CrCl <15 (thromboembolism/stroke prophylaxis use) | *CrCl <15 (thromboembolism/stroke prophylaxis use) | ||
*Acute PE | *Acute [[PE]] with hemodynamic instability | ||
*Acute PE requiring thrombolysis or pulmonary embolectomy | *Acute [[PE]] requiring thrombolysis or pulmonary embolectomy | ||
==Adverse Reactions== | ==Adverse Reactions== | ||
===Serious=== | ===Serious=== | ||
*Bleeding, severe | *[[Anticoagulant reversal for life-threatening bleeds|Bleeding, severe]] | ||
*Epidural/spinal hematoma | **[[Andexanet alfa]] | ||
*Thrombocytopenia | *Epidural/[[spinal hematoma]] | ||
*[[Thrombocytopenia]] | |||
*Agranulocytosis | *Agranulocytosis | ||
*Hypersensitivity | *Hypersensitivity reaction | ||
*Stevens-Johnson syndrome | *[[Stevens-Johnson syndrome]] | ||
*Hepatitis | *[[Hepatitis]] | ||
===Common=== | ===Common=== | ||
*Bleeding | *Bleeding | ||
*Back pain | *[[Back pain]] | ||
*Pruritus | *[[Pruritus]] | ||
*Elevated ALT | *Elevated ALT | ||
*Thrombocytopenia | *[[Thrombocytopenia]] | ||
==Pharmacology== | ==Pharmacology== | ||
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*Inhibits platelet activation and fibrin clot formation via direct, selective and reversible inhibition of factor Xa in both the intrinsic and extrinsic coagulation pathways | *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]] | |||
*[[Andexanet alfa]] | |||
==References== | ==References== | ||
*UpToDate | |||
[[Category: | *Epocrates | ||
<references/> | |||
[[Category:Pharmacology]] | |||
Latest revision as of 02:55, 19 October 2023
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
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.