From the Guidelines
Rivaroxaban should be dosed at 15 mg orally twice daily with food for the first 21 days, followed by 20 mg once daily with food for the remainder of treatment for deep vein thrombosis (DVT) treatment. This dosing regimen is based on the most recent and highest quality study available, which demonstrated its efficacy and safety in patients with DVT 1. The total duration of therapy depends on the specific circumstances but generally ranges from 3-6 months for provoked DVT and may be longer or indefinite for unprovoked DVT or recurrent events.
- It's essential to ensure normal kidney function before starting rivaroxaban, as dose adjustments are needed for patients with renal impairment.
- Rivaroxaban works by directly inhibiting Factor Xa in the coagulation cascade, preventing the formation of thrombin and thus clot formation.
- Patients should be advised that missing doses could increase thrombotic risk, and they should report any unusual bleeding or bruising.
- Unlike warfarin, rivaroxaban doesn't require routine blood monitoring but does carry bleeding risks that should be discussed with patients. The NCCN guidelines also support this dosing regimen, recommending rivaroxaban as an option for anticoagulation treatment of VTE in patients with cancer, with a dosing regimen of 15 mg orally twice daily for the first 21 days, followed by 20 mg once daily with food 1.
From the FDA Drug Label
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 Rivaroxaban for initial treatment of DVT is 15 mg or 20 mg tablets with food, taken at approximately the same time every day. For patients at continued risk of recurrent DVT after at least 6 months of initial treatment, the recommended dose is 10 mg once daily, with or without food 2.
From the Research
Rivaroxiban Dose for DVT
- The recommended dose of rivaroxaban for the treatment of deep vein thrombosis (DVT) is 15 mg twice daily for 21 days, followed by 20 mg once daily 3.
- A study found that rivaroxaban had an efficacy superior to warfarin in terms of vessel patency after six months of therapy, with similar adverse events in both groups 3.
- Another study compared the effectiveness and safety of rivaroxaban and edoxaban in treating lower extremity DVT, and found that rivaroxaban had a higher reduction in recurrent thrombosis, but no significant differences in major bleeding 4.
- A dose-ranging study evaluated once-daily oral administration of rivaroxaban in the treatment of patients with acute symptomatic DVT, and found that the primary efficacy outcome occurred in 6.1%, 5.4%, and 6.6% of the rivaroxaban 20-, 30-, and 40-mg treatment groups, respectively 5.
- A real-world study described the prescribing practices of apixaban or rivaroxaban lead-in doses for the treatment of VTE in hospitalized patients, and found that prescribing patterns of OFXAi lead-in therapy duration are variable in patients receiving initial parenteral anticoagulation 6.
Dosage Regimens
- Rivaroxaban can be administered at a fixed oral dose, without requiring routine coagulation monitoring 7.
- The EINSTEIN-DVT and EINSTEIN-PE trials used a single-drug approach with rivaroxaban, which was shown to be noninferior to standard therapy consisting of subcutaneous enoxaparin sodium overlapping with and followed by an oral dose-adjusted vitamin K antagonist (enoxaparin-VKA) 7.
- Extended prophylaxis with rivaroxaban reduced the incidence of symptomatic recurrent VTE to a greater extent than placebo, but was associated with a non-significant increase in the risk of clinically relevant bleeding compared with placebo 7.