Indicated in non-rheumatic AF with one of the following previous stroke or transient ischaemic attack, CCF, age > 75 years, diabetes mellitus or hypertension
- Prevent stroke/systemic embolism in non-valvular AF with additional risk factor
- Check BNF or equivalent for UpToDate prescribing advice
- Alternative to Warfarin - approximately £3 per day
- Clots are formed by fibrin from fibrinogen
- It is a direct factor Xa inhibitor
- Targets free and clot-bound Factor Xa in the prothrombinase complex
- Half life about 12 hours and 66% renal excretion
- Non valvular AF: For patients with CrCl >50 mL/min: 20 mg PO OD with the evening meal, For patients with CrCl 15 - 50 mL/min: 15 mg PO OD with the evening meal
- VTE prophylaxis: Following knee replacement surgery Rivaroxaban 10 mg OD for 2 weeks, to be started 6-10 hours after surgery.
- VTE prophylaxis: Following hip replacement surgery: Rivaroxaban 10 mg OD for 5 weeks, to be started 6-10 hours after surgery.
- DVT and PE: Rivaroxaban 15 mg BD for 21 days, to be taken with food. then 20 mg once daily. Some may need only 15 mg OD.
- ACS: Rivaroxaban 2.5 mg BD usually for 12 months
- Increased bleeding risk with Aspirin, P2Y12 platelet inhibitors, other
antithrombotic agents, fibrinolytic therapy, and NSAID
- Avoid with Cytochrome P450 3a4 Inducers: carbamazepine, phenytoin, rifampicin, St. John's wort
- Avoid with Cytochrome P450 3a4 Inhibitors: Ketoconazole,
- Renal failure, Liver disease
- Renal failure, Active pathological bleeding, Severe hypersensitivity reaction
- Significant risk of major bleeding: GI ulcer, oesophageal varices
- Recent brain, spine, or ophthalmic surgery
- Recent intracranial haemorrhage, malignant neoplasms, vascular aneurysm
- Bleeding, falls, abdominal pain, Nausea, Vomiting, Headache, Constipation