From the Guidelines
For DVT prophylaxis in hospitalized medical patients, Xarelto (rivaroxaban) is typically recommended at a dose of 10 mg once daily, as supported by the most recent and highest quality study 1. The duration of prophylaxis generally continues throughout the hospitalization period and may extend for a total of 31-39 days in patients at high risk for VTE. Key considerations for the use of Xarelto include:
- Renal function assessment before starting therapy, with dose adjustments necessary for patients with severe renal impairment (CrCl <30 mL/min) 1
- Administration with food to enhance absorption
- Monitoring for signs of bleeding, the primary adverse effect
- Contraindication in patients with active pathological bleeding or severe liver disease
- Discontinuation at least 24 hours before procedures due to anticoagulant effects The mechanism of action of Xarelto involves direct inhibition of Factor Xa, preventing thrombin formation and subsequent clot development. Overall, the use of Xarelto for DVT prophylaxis in hospitalized medical patients is supported by recent guidelines and studies, with a focus on balancing the benefits of thromboprophylaxis with the risks of bleeding complications 1.
From the FDA Drug Label
For the tablets, advise the patient and/or caregiver to read the FDA-approved patient labeling (Medication Guide). Advise patients for initial treatment of DVT and/or PE to take XARELTO 15 mg or 20 mg tablets with food at approximately the same time every day [see Dosage and Administration (2. 1)] . Advise patients who are at a continued risk of recurrent DVT and/or PE after at least 6 months of initial treatment, to take XARELTO 10 mg once daily with or without food [see Dosage and Administration (2.1)].
The recommended dose of Xarelto (rivaroxaban) for DVT prophylaxis in inpatients is not explicitly stated in the provided drug label. However, for the treatment of DVT, the initial dose is 15 mg twice daily with food for the first 21 days, but this information is not present in the label text provided.
- The duration of treatment is at least 6 months for the treatment of DVT, after which 10 mg once daily can be considered for continued risk of recurrent DVT. However, the provided label does not directly address DVT prophylaxis in inpatients. 2
From the Research
Xarelto DVT Prophylaxis Inpatient
- The recommended dose and duration of Xarelto (rivaroxaban) for Deep Vein Thrombosis (DVT) prophylaxis in inpatients is not explicitly stated in the provided studies.
- However, according to the study 3, rivaroxaban is approved for the initial treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), as well as the prevention of recurrent DVT and PE, at a fixed oral dose of 10 mg once daily for prophylaxis.
- The study 4 also mentions that oral rivaroxaban 10 mg once daily was more effective than subcutaneous enoxaparin 40 mg once daily in preventing postoperative VTE in patients undergoing total hip replacement (THR) or total knee replacement (TKR) surgery.
- The optimal duration of anticoagulation after VTE is controversial and complicated by the need for individualised assessment and balance between thrombosis and bleeding risks, as stated in the study 5.
- Extended prophylaxis with rivaroxaban reduced the incidence of symptomatic recurrent VTE to a greater extent than placebo in the EINSTEIN-Extension trial, but was associated with a non-significant increase in the risk of clinically relevant bleeding compared with placebo, as mentioned in the study 3.
- The studies 6 and 7 discuss the use of low-dose apixaban or rivaroxaban as secondary prophylaxis of upper extremity deep vein thrombosis and venous thromboembolism (VTE) in major-thrombophilia carriers, but do not provide specific guidance on the dose and duration of Xarelto for DVT prophylaxis in inpatients.