Rivaroxaban Dosing for DVT Prophylaxis
For DVT prophylaxis after orthopedic surgery (hip or knee replacement), rivaroxaban 10 mg once daily is the recommended dose, starting 6-10 hours post-operatively and continuing for 10-14 days (up to 35 days for extended prophylaxis). 1, 2
Clinical Context-Specific Dosing
Post-Orthopedic Surgery (Hip/Knee Replacement)
- Standard dose: 10 mg once daily 1
- Timing: Initiate 6-10 hours after surgery 1
- Duration: Continue for 10-14 days as standard; consider extending up to 35 days for high-risk patients 1
- This dosing was shown to be noninferior to LMWH in clinical trials 1
Acutely Ill Medical Patients (Hospitalized)
- Rivaroxaban is NOT recommended for VTE prophylaxis in general medical inpatients 1
- The MAGELLAN trial showed rivaroxaban was associated with fewer VTE events but at the cost of higher bleeding risk compared to enoxaparin 1
- Alternative options: LMWH (enoxaparin 40 mg SC daily), low-dose UFH, or fondaparinux 2.5 mg SC daily 1
Cancer-Associated Superficial Vein Thrombosis (SVT)
- Prophylactic dose: 10 mg once daily for specific indications 1
- Use when SVT is >5 cm in length or extends above the knee 1
- Continue for at least 6 weeks 1
- Note: This represents a specialized use case where prophylactic-dose rivaroxaban has demonstrated efficacy 1
Important Distinctions: Prophylaxis vs. Treatment
Do not confuse prophylactic dosing with treatment dosing. The question asks about prophylaxis, not treatment of established DVT:
- Prophylaxis dose: 10 mg once daily 1, 2
- Treatment dose (for established DVT): 15 mg twice daily for 21 days, then 20 mg once daily 3, 2, 4, 5
Administration Guidelines
- Food requirements: The 10 mg prophylactic dose can be taken with or without food 2
- No coagulation monitoring required 3, 2
- Renal considerations: Avoid in severe renal failure (CrCl <15 mL/min); no dose adjustment needed for CrCl 30-49 mL/min in the prophylaxis setting 3, 2
Clinical Pitfalls to Avoid
Common error: Using treatment doses (15 mg BID or 20 mg daily) for prophylaxis—this significantly increases bleeding risk without additional benefit in the prophylactic setting 1
Setting-specific limitation: While rivaroxaban 10 mg daily is effective for post-surgical orthopedic prophylaxis, it should not be routinely used for medical inpatient prophylaxis where LMWH remains the preferred agent 1
Duration consideration: Extended prophylaxis beyond 10-14 days (up to 35 days) should be considered for patients at continued high risk, particularly after hip replacement surgery 1