Normal Rivaroxaban Dosing for Hip Surgery Post-Op
For patients undergoing hip replacement surgery, the normal dose of rivaroxaban (Xarelto) is 10 mg once daily, starting 6-10 hours after surgery and continuing for 5 weeks (35 days). 1, 2
Dosing Regimen Details
- Rivaroxaban 10 mg should be administered orally once daily for thromboprophylaxis after hip replacement surgery 1
- Treatment should be initiated between 6 and 10 hours after surgery, once hemostasis has been established 1, 2
- The recommended duration of treatment for total hip replacement is 5 weeks (35 days) 2
- The dose does not need to be adjusted based on age, gender, or body weight for most patients 1
Special Considerations
- Rivaroxaban is not recommended for patients with severe renal failure (creatinine clearance <15 mL/min) 1
- The drug should be avoided in patients with hepatic disease associated with coagulopathy 1
- Concomitant systemic treatment with azole-antimycotics or HIV protease inhibitors may contraindicate rivaroxaban use 1
- Rivaroxaban is not approved for use in children, adolescents under 18 years, pregnant women, or during breastfeeding 1
Perioperative Management
- For patients already on rivaroxaban requiring hip surgery, the medication should be stopped 2 days before surgery (skip 1 dose) for patients with normal renal function 1
- After surgery, rivaroxaban can be resumed at 10 mg once daily starting the day after surgery (24 hours postoperative) for procedures with low bleeding risk 1
- For procedures with high bleeding risk, resume rivaroxaban 2-3 days after surgery (48-72 hours postoperative) 1
Efficacy and Safety
- Clinical trials have demonstrated that rivaroxaban 10 mg once daily is more effective than enoxaparin 40 mg once daily in preventing venous thromboembolism (VTE) after hip replacement surgery 2, 3
- In the RECORD 1 study, total VTE occurred in only 1.1% of rivaroxaban recipients compared to 3.7% of enoxaparin recipients 2, 3
- Major bleeding rates were similar between rivaroxaban (0.3%) and enoxaparin (0.1%) in clinical trials 3
Common Pitfalls to Avoid
- Inadequate duration of prophylaxis - ensure the full 5-week course is completed for hip replacement patients 1, 2
- Initiating treatment too early after surgery (before adequate hemostasis is achieved) may increase bleeding risk 1
- Failure to adjust dosing in patients with severe renal impairment 1
- Using PT or aPTT to monitor the anticoagulant effect of rivaroxaban - these tests are not reliable for this purpose 1
- Overlooking potential drug interactions, particularly with medications that affect CYP3A4 and P-glycoprotein pathways 1