From the Guidelines
For patients with pulmonary embolism (PE) on Xarelto (rivaroxaban), follow-up should include an initial visit 2-4 weeks after diagnosis, then at 3-6 month intervals during anticoagulation therapy, with consideration of extended oral anticoagulation of indefinite duration in certain cases, as recommended by the 2019 ESC guidelines 1. The standard treatment duration is 3 months for provoked PE (with reversible risk factors) and at least 6-12 months for unprovoked PE.
- During follow-up visits, clinicians should assess for:
- Bleeding complications
- Medication adherence
- Symptom resolution
- Potential drug interactions
- Complete blood count, renal and liver function tests should be monitored periodically, especially in elderly patients or those with impaired organ function, as suggested by the guidelines 1. No routine anticoagulation monitoring is required for Xarelto, unlike warfarin.
- Patients should be evaluated for:
- Post-PE syndrome (persistent dyspnea, decreased exercise tolerance)
- Chronic thromboembolic pulmonary hypertension, particularly if symptoms persist These follow-up guidelines are important because they allow for timely detection of complications, assessment of treatment efficacy, and appropriate decisions regarding anticoagulation duration, balancing the risk of recurrent thrombosis against bleeding risk, as supported by recent studies 1. If extended oral anticoagulation is decided after PE in a patient without cancer, a reduced dose of the NOACs apixaban (2.5 mg b.i.d.) or rivaroxaban (10 mg o.d.) should be considered after 6 months of therapeutic anticoagulation, as recommended by the 2019 ESC guidelines 1.
From the Research
Current Follow-up Guidelines for Pulmonary Embolism Patients on Xarelto (Rivaroxaban)
- The current follow-up guidelines for patients with pulmonary embolism (PE) on Xarelto (rivaroxaban) involve regular monitoring to prevent recurrence and minimize the risk of bleeding 2, 3, 4.
- Patients with PE and a systolic blood pressure of 90 mm Hg or higher can be treated with direct oral anticoagulants such as rivaroxaban, which has been shown to be noninferior to standard therapy consisting of heparin combined with a vitamin K antagonist 2.
- The efficacy and safety of rivaroxaban have been demonstrated in real-world studies, with no significant difference in thrombus absorption compared to standard therapy 3.
- Rivaroxaban is generally well tolerated, with no significant between-group differences in clinically relevant bleeding compared to standard therapy 4.
- Extended prophylaxis with rivaroxaban can reduce the incidence of symptomatic recurrent venous thromboembolism (VTE) 4.
- Patients on rivaroxaban should have their kidney function assessed prior to and during continued therapy to ensure consistency with the drug label 5.
Monitoring and Follow-up
- Regular monitoring of patients on rivaroxaban includes assessment of kidney function, liver function, and bleeding risk 5.
- Patients should be educated on the signs and symptoms of bleeding and recurrence of PE, and instructed to seek medical attention immediately if they occur 2, 3, 4.
- Follow-up appointments should be scheduled regularly to monitor the patient's condition and adjust the treatment plan as needed 2, 3, 4.
Treatment Duration
- The optimal duration of anticoagulation therapy for patients with PE is not well established, but it is generally recommended to continue treatment for at least 3-6 months 2, 6.
- The decision to extend or discontinue anticoagulation therapy should be based on the individual patient's risk of recurrence and bleeding 2, 6.