Rivaroxaban (PE Treatment)

How it works

It directly and reversibly inhibits factor Xa, reducing thrombin generation and the propagation of clot.

Prescribing in practice

• The main hazard is bleeding, so assess bleeding risk, avoid in severe renal or hepatic impairment and active clinically significant bleeding, and counsel patients to recognise and report it.
• Take the treatment and maintenance doses with food to ensure reliable absorption, and adhere to the higher-intensity initial regimen for PE.
• Review concomitant antiplatelets, NSAIDs and strong CYP3A4 or P-glycoprotein interacting drugs that alter bleeding risk or exposure.

Monitoring

Monitor renal function, full blood count and for signs of bleeding, with routine coagulation monitoring not required.

Counselling the patient

• Take the tablets with food and never miss doses, as stopping early raises clot risk.
• Seek urgent help for unusual bruising, black stools, blood in urine or prolonged bleeding.
• Carry an anticoagulant alert card and tell any dentist or surgeon.

Evidence & guidelines

NICE and trial evidence support rivaroxaban for treating pulmonary embolism and preventing recurrent venous thromboembolism.