Description: Direct oral anticoagulant; Factor Xa Inhibitor
“ALERT: US Boxed Warning
Premature discontinuation increases the risk of thrombotic events:
Premature discontinuation of any oral anticoagulant, including rivaroxaban, increases the risk of thrombotic events. If anticoagulation with rivaroxaban is discontinued for a reason other than pathological bleeding or completion of a course of therapy, consider coverage with another anticoagulant.
Epidural or spinal hematomas have occurred in patients treated with rivaroxaban who are receiving neuraxial anesthesia or undergoing spinal puncture. These hematomas may result in long-term or permanent paralysis. Consider these risks when scheduling patients for spinal procedures. Factors that can increase the risk of developing epidural or spinal hematomas in these patients include use of indwelling epidural catheters; concomitant use of other drugs that affect hemostasis, such as nonsteroidal anti-inflammatory drugs (NSAIDs), platelet inhibitors, or other anticoagulants; a history of traumatic or repeated epidural or spinal punctures; or a history of spinal deformity or spinal surgery. The optimal timing between the administration of rivaroxaban and neuraxial procedures is not known.
Monitor patients frequently for signs and symptoms of neurological impairment. If neurological compromise is noted, urgent treatment is necessary.
Consider the benefits and risks before neuraxial intervention in patients who are anti-coagulated or are to be anti-coagulated for thromboprophylaxis.”
CSA NA – FDA Approved – REMS (N) – Can Ship
How Does It Work
Rivaroxaban/Xarelto reversibly inhibits factor Xa which is responsible for catalyzing the conversion of prothrombin to thrombin as part of both the intrinsic and extrinsic coagulation pathways. Thrombin activates platelets and catalyzes the conversion of fibrinogen to fibrin. Blocking factor Xa thereby results in inhibited platelet activation and fibrin clot formation.
Indications For Use
Rivaroxaban/Xarelto is officially indicated for atrial fibrillation, coronary artery disease, or peripheral artery disease. It is also prescribed off-label for heparin-induced thrombocytopenia, superficial vein thrombosis, venous thromboembolism, deep vein thrombosis, or pulmonary embolism. (maybe used for conditions not listed)
Before starting Rivaroxaban/Xarelto make sure your physician is aware of any allergies or medications you currently take, if you have kidney disease, if you have liver disease if you have valvular disease if you have had bariatric surgery, if you have a bleeding disorder or active pathological bleed (such as an ulcer), or if you are pregnant or breastfeeding
2.5-20mg once or twice daily depending on the condition it is being used for
Pharmacist Tips On Using
How to Take: Follow instructions provided by physician/pharmacy label, take consistently at same times each day unless otherwise directed, store at room temperature. Doses greater than or equal to 15mg should be taken with food, doses lower than this could be with or without.
You Need to Avoid: Do not stop this medication suddenly or without the involvement of your physician. Prematurely stopping this medication can cause an increased risk of a thrombotic event such as stroke so generally if changing medications, a bridging schedule is required. If the medication is to be discontinued follow your physician’s instructions, the exception to this is if a major bleed is occurring in which case it must be stopped immediately, and emergency medical attention is required. If a dosage is missed the general recommendation is to take the dosage as soon as you remember and then to continue your normal dosing schedule the following day. Confirm with your physician if you are wanting to use any NSAIDs such as ibuprofen, ASA, or naproxen. Do not self-select over the counter items such as these without asking a medical professional due to the risk of ulceration and a severe hemorrhage.
The main side effects are bruising and hemorrhage (bleeding) both minor and major. The patient should monitor for weakness, dizziness, unexplained edema, black tarlike stool, what appears to be coffee grounds in vomit, major unexplained bruising, minor cuts that do not stop bleeding, blood when brushing teeth etc. These are signs of over anticoagulation or an internal bleed in which case immediate medical attention is required.
Note this is not a complete list of side effects, only common ones
Frequently Asked Questions
Why would my doctor give this to me if it can cause me to have a potentially fatal bleed, is it safe?
Your physician has found that given your medical conditions the reduction of risk of a major clot resulting in a heart attack or stroke far outweighs the increased risk of a bleed. Every medication does have risks however the training of your medical team has established that the benefits outweigh said risks based on their many years of experience, schooling, training, and available clinical data.