Rivaroxaban

How it works

It directly and selectively inhibits activated factor Xa, interrupting the coagulation cascade and reducing thrombin generation and clot formation.

Prescribing in practice

• It increases bleeding risk, so assess bleeding and thrombotic risk, avoid in significant active bleeding, and note that treatment-dose regimens should be taken with food for reliable absorption.
• It is contraindicated in significant hepatic disease with coagulopathy and in valvular atrial fibrillation and mechanical heart valves, and the antiphospholipid syndrome is a caution.
• Renal impairment and strong combined CYP3A4 and P-glycoprotein inhibitors or inducers (such as azole antifungals, some HIV protease inhibitors, or rifampicin) materially alter exposure.

Monitoring

Monitor renal and hepatic function and full blood count periodically and review for signs of bleeding; routine coagulation monitoring is not required.

Counselling the patient

• Take treatment doses with food and do not stop suddenly without advice.
• Report unusual bruising, bleeding that will not stop, black stools or red urine.
• Carry an anticoagulant alert card and tell any dentist or surgeon before procedures.

Evidence & guidelines

Rivaroxaban is recommended by NICE for treatment of venous thromboembolism and stroke prevention in non-valvular atrial fibrillation.