From the Research
For a 39-year-old male taking Xarelto (rivaroxaban) 15mg twice daily after a leg fracture, the most recent and highest quality evidence suggests continuing this medication for a total of 2-3 weeks following the injury, then reassessing with a healthcare provider 1. After the initial treatment period, the doctor may reduce the dose to 10mg once daily for an additional 2-3 months, depending on specific risk factors and mobility status. It is crucial not to stop taking Xarelto suddenly without medical guidance, as this could increase the risk of developing a blood clot. The medication should be taken with food at approximately the same times each day to maintain consistent blood levels. If any unusual bleeding, severe bruising, or persistent headaches occur while on Xarelto, immediate medical attention should be sought. The purpose of this medication is to prevent dangerous blood clots that can form due to reduced mobility after a fracture. The initial higher dose provides more intensive protection during the highest risk period immediately following injury, while the body is most immobilized.
Some key points to consider:
- The risk of venous thromboembolism is high in patients undergoing fracture-related major orthopedic surgery, but data on pharmacological thromboprophylaxis are limited 2.
- Rivaroxaban has been shown to be effective in preventing recurrent venous thromboembolism with a favorable safety profile 3.
- A dose of 10mg once daily should be the priority in patients receiving long-term rivaroxaban anticoagulation therapy, in view of reduced bleeding risk 1.
- Apixaban has been compared to rivaroxaban in patients with venous thromboembolism, showing a lower rate for recurrent VTE and bleeding with apixaban 4.
- Aspirin may be an effective, safe, convenient, and cheap alternative for extended prophylaxis after hip fracture surgery 5.
However, the most recent and highest quality study 1 provides the best guidance for the management of Xarelto in this patient. Therefore, continuing Xarelto 15mg twice daily for 2-3 weeks, then reassessing and potentially reducing the dose to 10mg once daily, is the recommended course of action.