see also:

• anticoagulants
• warfarin
• enoxaparin
• apixaban
• dabigatran

• introduced in Australia in 2009 as Xarelto, initially on PBS for post-op THR patients but in 2013, this was expanded to include Rx of PE and/or DVT.
• an orally active Factor Xa inhibitor
• used as an option in the prevention and Rx of deep venous thrombosis (DVT) & pulmonary embolism (PE), and in atrial fibrillation
• appears to prevent more DVTs than enoxaparin but major bleeding post THR was 0.3% in the rivaroxaban group vs 0.1% in the enoxaparin group
• no anticoagulant effect monitoring required in short term use
• no antidote for overdosage

• onset of action ~3hrs after dose and lasts 8-12hrs but factor Xa activity does not return to normal within 24hrs allowing once daily dosing

• usual dose in adults:
  • prophylactic dose for DVT post-op THR/TKR: 10mg once daily orally
  • Rx of pulmonary embolism (PE) and prevention of recurrent deep venous thrombosis (DVT):
    • 15mg bd (42 tablets on streamlined authority PBS) for 1st 3 weeks, then 20mg once daily (28 tablets, 5 rpts on streamlined authority PBS)
    • use apixaban instead as half the bleeding risk
  • prevention of stroke (CVA) in non-valvular atrial fibrillation:
    • 20mg once daily (15mg if CrCl 30-49ml/min)
• should be taken with food

• major bleeding risk
• severe liver disease associated with coagulopathy
• renal disease (creatinine clearance < 30ml/min if Rx dose, creatinine clearance < 15ml/min id prophylactic 10mg/d dose) as partly excreted in urine unchanged
• hypersensitivity
• pregnancy
• lactation

• bleeding, bruising
  • risk appears to be increased if also taking diltiazem
  • apixaban appears to be safer for those with DVT/PE as it appears to halve the risk of major bleeding (3.3% vs 7.1% with rivaroxaban)¹⁾
• increased transaminases
• constipation, diarrhoea, nausea, fever, peripheral oedema, headache, etc