Rivaroxaban: Difference between revisions
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==Adult Dosing== | ==Adult Dosing== | ||
*Thromboembolism/[[stroke]] prophylaxis: 20mg PO | *Thromboembolism/[[stroke]] prophylaxis: 20mg PO QD | ||
*[[DVT]] Prophylaxis: 10mg PO | *[[DVT]] Prophylaxis: 10mg PO QD x35 days; Start: 6-10h post-op once hemostasis established | ||
*[[DVT]]/[[PE]] Prophylaxis, recurrent: 20mg PO | *[[DVT]]/[[PE]] Prophylaxis, recurrent: 20mg PO QD | ||
*[[DVT]]/[[PE]] Treatment: 20mg PO | *[[DVT]]/[[PE]] Treatment: 20mg PO QD | ||
*[[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>: | *[[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 | **Rivaroxaban 15 mg/day plus [[clopidogrel]] for 12 months post-stenting just as efficacious to current standard | ||
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===Renal Dosing=== | ===Renal Dosing=== | ||
*Thromboembolism/[[stroke]] prophylaxis | *Thromboembolism/[[stroke]] prophylaxis | ||
**CrCl 15-50: 15mg | **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 | ||
Revision as of 10:31, 7 July 2017
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[1]:
- 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
- ↑ Gibson CM et al. Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI. N Engl J Med 2016 Nov 14.