Overview
Rivaroxaban is a direct oral anticoagulant that selectively inhibits factor Xa, preventing thrombin generation and clot formation. It is used for stroke prevention in nonvalvular atrial fibrillation, treatment and prevention of venous thromboembolism, and reducing cardiovascular events in certain patients with coronary or peripheral artery disease.
Mechanism of Action
Rivaroxaban is a direct factor Xa inhibitor that selectively blocks the active site of factor Xa, preventing the conversion of prothrombin to thrombin and thereby inhibiting thrombus formation.
Indications
- Reduction of risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation
- Treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE)
- Prophylaxis of DVT following hip or knee replacement surgery
- Reduction of risk of major cardiovascular events in patients with chronic coronary artery disease or peripheral artery disease
Common Doses
- 10 mg
- 15 mg
- 20 mg
Dosage
Dosage varies by indication: 20 mg once daily with evening meal for atrial fibrillation; 15 mg twice daily for 21 days followed by 20 mg once daily for DVT/PE treatment; 10 mg once daily for DVT prophylaxis after orthopedic surgery. Renal function must be considered for dosing adjustments.
Contraindications
- Active pathological bleeding
- Severe hypersensitivity reaction to rivaroxaban
Side Effects
- Bleeding complications (including major and fatal bleeding)
- Hematoma formation
- Hypersensitivity reactions
- Elevated liver enzymes
Interactions
- Strong CYP3A4 and P-gp inhibitors (e.g., ketoconazole, ritonavir) increase rivaroxaban exposure
- Strong CYP3A4 inducers (e.g., rifampin, carbamazepine) decrease rivaroxaban efficacy
- Anticoagulants and antiplatelet agents increase bleeding risk
Counseling Points
- Take with evening meal for optimal absorption
- Do not stop without medical advice due to stroke risk
- Report any signs of bleeding immediately
- Inform all healthcare providers about rivaroxaban use
- Avoid activities with high bleeding risk