rivaroxaban

Last edited 07/2019

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.