Rivaroxaban Daily Dose for DVT Prophylaxis
For DVT prophylaxis, rivaroxaban 10 mg once daily is the recommended dose, specifically indicated for patients undergoing orthopedic surgery such as hip or knee replacement. 1
Orthopedic Surgery Prophylaxis
- Rivaroxaban 10 mg once daily should be initiated 6-10 hours post-operatively and continued for 10-14 days for knee replacement surgery 1
- For hip replacement surgery, extend prophylaxis up to 35 days in high-risk patients to prevent DVT 1
- This dosing regimen demonstrated noninferior efficacy compared to enoxaparin 40 mg subcutaneously once daily in large clinical trials 2
- No coagulation monitoring is required, and the dose can be taken with or without food 1
Important Clinical Context: Not for Medical Inpatients
- Rivaroxaban is NOT recommended for VTE prophylaxis in general medical inpatients 1
- For hospitalized medical patients, LMWH, low-dose unfractionated heparin, or fondaparinux remain the preferred agents 1
Critical Distinction: Prophylaxis vs. Treatment Dosing
A common and dangerous pitfall is confusing prophylactic and treatment doses:
- Prophylaxis dose: 10 mg once daily (for orthopedic surgery) 1
- Treatment dose for established DVT: 15 mg twice daily for 21 days, then 20 mg once daily 3, 4
- Using treatment doses for prophylaxis significantly increases bleeding risk without additional benefit 1
Renal Considerations
- Avoid rivaroxaban in severe renal failure (CrCl <15 mL/min) 1
- No dose adjustment is needed for moderate renal impairment during prophylaxis 1