From the Guidelines
Xorelto (rivaroxaban) is a suitable option for preventing blood clots and reducing stroke risk in patients with atrial fibrillation, with a typical dosing of 20 mg once daily with food, as evidenced by the ROCKET-AF trial 1. The medication works by directly inhibiting Factor Xa in the coagulation cascade, preventing thrombin formation and subsequent clot development.
- Key considerations for Xorelto use include:
- Typical dosing: 20 mg once daily with food for stroke prevention in atrial fibrillation
- Dose adjustments needed for patients with reduced kidney function, with a recommended dose reduction to 15 mg once daily in patients with creatinine clearance of 15 to 50 mL/min 1
- Bleeding risks, particularly gastrointestinal bleeding, which was found to be similar between rivaroxaban and warfarin in the ROCKET-AF trial 1
- Importance of informing all healthcare providers about taking Xorelto before any procedures and reporting unusual bleeding or bruising immediately
- Compared to other direct oral anticoagulants (DOACs), such as apixaban and edoxaban, Xorelto has been shown to have similar efficacy and safety profiles, with some differences in dosing and bleeding risks 1
- The 2018 update on antithrombotic therapy in patients with atrial fibrillation treated with oral anticoagulation undergoing percutaneous coronary intervention provides guidance on the use of Xorelto in this patient population, highlighting the importance of careful consideration of bleeding risks and dose adjustments 1
From the FDA Drug Label
Reducing the risk of a sudden decrease in blood flow to the legs, major amputation, serious heart problems or stroke in people with peripheral artery disease including those who have recently had a procedure to improve blood flow to the legs: Take XARELTO 2. 5 mg 2 times a day with or without food. The recommended dose of XARELTO for reducing the risk of a sudden decrease in blood flow to the legs, major amputation, serious heart problems, or stroke in people with peripheral artery disease is 2.5 mg twice a day.
- This dose should be taken with or without food.
- Patients should also take aspirin 75 mg to 100 mg once a day as instructed by their doctor 2.
From the Research
Xarelto (Rivaroxaban) Overview
- Xarelto, also known as Rivaroxaban, is a direct factor Xa inhibitor used for the prevention of stroke and systemic embolism in patients with atrial fibrillation 3.
- It is administered at a fixed oral dose and does not require routine monitoring of coagulation parameters 3.
Indications and Usage
- Rivaroxaban is approved for several indications, including reduction of risk of stroke and systemic embolism in nonvalvular atrial fibrillation, treatment of deep vein thrombosis, and treatment of pulmonary embolism 4.
- It is also used for prophylaxis of deep vein thrombosis following hip or knee replacement surgery, and for reduction of risk of major cardiovascular events in patients with chronic coronary artery disease or peripheral artery disease 4.
Renal Impairment Considerations
- Rivaroxaban can be used in patients with renal impairment, but the benefits and risks of intervention should be carefully assessed and balanced 4.
- Patients with moderate renal impairment may require a reduced dosage of rivaroxaban (15 mg once daily) 3.
- Studies have shown that apixaban, another factor Xa inhibitor, may be a reasonable alternative to warfarin in patients with severe renal impairment 5, 6, 7.
Safety and Efficacy
- The safety and efficacy of rivaroxaban have been evaluated in several studies, including the ROCKET AF trial, which showed that rivaroxaban was noninferior to warfarin in preventing stroke and systemic embolism in patients with nonvalvular atrial fibrillation 3.
- Studies have also shown that apixaban is associated with a lower risk of major bleeding compared to warfarin in patients with advanced chronic kidney disease or end-stage renal disease 7.