Makindo Medical Notes

Indicated in non-rheumatic AF with one of the following previous stroke or transient ischaemic attack, CCF, age > 75 years, diabetes mellitus or hypertension

About: Always check the BNF link here

• Prevent stroke/systemic embolism in non-valvular AF with additional risk factor
• Check BNF or equivalent for UpToDate prescribing advice
• Alternative to Warfarin - approximately £3 per day

Action

• Clots are formed by fibrin from fibrinogen
• It is a direct factor Xa inhibitor
• Targets free and clot-bound Factor Xa in the prothrombinase complex
• Half life about 12 hours and 66% renal excretion

Indications

• Non valvular AF: For patients with CrCl >50 mL/min: 20 mg PO OD with the evening meal, For patients with CrCl 15 - 50 mL/min: 15 mg PO OD with the evening meal
• VTE prophylaxis: Following knee replacement surgery Rivaroxaban 10 mg OD for 2 weeks, to be started 6-10 hours after surgery.
• VTE prophylaxis: Following hip replacement surgery: Rivaroxaban 10 mg OD for 5 weeks, to be started 6-10 hours after surgery.
• DVT and PE: Rivaroxaban 15 mg BD for 21 days, to be taken with food. then 20 mg once daily. Some may need only 15 mg OD.
• ACS: Rivaroxaban 2.5 mg BD usually for 12 months

Interactions

• Increased bleeding risk with Aspirin, P2Y12 platelet inhibitors, other antithrombotic agents, fibrinolytic therapy, and NSAID
• Avoid with Cytochrome P450 3a4 Inducers: carbamazepine, phenytoin, rifampicin, St. John's wort
• Avoid with Cytochrome P450 3a4 Inhibitors: Ketoconazole, ritonavir, Clarithromycin, Erythromycin and Fluconazole

Cautions

• Renal failure, Liver disease

Contraindications

• Renal failure, Active pathological bleeding, Severe hypersensitivity reaction
• Significant risk of major bleeding: GI ulcer, oesophageal varices
• Recent brain, spine, or ophthalmic surgery
• Recent intracranial haemorrhage, malignant neoplasms, vascular aneurysm

Side effects

• Bleeding, falls, abdominal pain, Nausea, Vomiting, Headache, Constipation