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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
  • 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
  • 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
  • Increased bleed risk with Aspirin, P2Y12 platelet inhibitors, other anti -thrombotic 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
  • Renal failure, Liver disease
  • 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