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Factor Xa Inhibitor (DOAC)

Rivaroxaban (VTE Prophylaxis — Orthopaedic)

Brand names: Xarelto

Rivaroxaban is an oral direct factor Xa inhibitor anticoagulant used here for venous thromboembolism prophylaxis after major orthopaedic surgery such as hip and knee replacement.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It directly and reversibly inhibits activated factor Xa, reducing thrombin generation and clot formation.

Prescribing in practice

  • Bleeding is the principal risk, so assess bleeding risk against thrombosis risk, time the first dose appropriately after surgery and around neuraxial anaesthesia, and review concurrent antiplatelets or other anticoagulants.
  • Avoid in significant renal or hepatic impairment and check for interacting drugs such as combined strong CYP3A4 and P-glycoprotein inhibitors or inducers.
  • There is no routine coagulation monitoring; a specific reversal agent and supportive measures are used for major bleeding.

Monitoring

Monitor renal function, haemoglobin and clinically for bleeding rather than routine clotting assays.

Counselling the patient

  • Report unusual bruising, bleeding that will not stop, black stools, or blood in urine.
  • Tell other healthcare staff and dentists that you are taking an anticoagulant.
  • Take the course as prescribed for the recommended duration after your operation.

Evidence & guidelines

NICE recommends a direct oral anticoagulant such as rivaroxaban as an option for VTE prophylaxis after elective hip and knee replacement.

Reference: RECORD 1–4 Trials; NICE TA170 (THR/TKR VTE prophylaxis); Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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