From the Guidelines
Alternatives to Rivaroxaban (Xarelto) include other Direct Oral Anticoagulants (DOACs) such as dabigatran, apixaban, and edoxaban. These alternatives are recommended for patients with nonvalvular atrial fibrillation (AF) who are at risk of stroke and systemic embolism 1.
- Dabigatran is an orally administered direct thrombin inhibitor that has been shown to be noninferior to warfarin in preventing stroke and systemic embolism in patients with AF 1.
- Apixaban is an orally administered direct factor Xa inhibitor that has been shown to be superior to warfarin in preventing stroke and systemic embolism in patients with AF, with a lower risk of major bleeding 1.
- Edoxaban is an orally administered direct factor Xa inhibitor that has been shown to be noninferior to warfarin in preventing stroke and systemic embolism in patients with AF, with a lower risk of major bleeding 1. It's worth noting that the selection of an antithrombotic agent should be individualized based on risk factors, cost, tolerability, patient preference, potential for drug interactions, and other clinical characteristics 1. Additionally, patients with severe renal impairment or those with a creatinine clearance (CrCl) <15 mL/min should not use rivaroxaban or other DOACs, and those with moderate renal impairment should use them with caution 1.
From the Research
Alternatives to Rivaroxaban (Xarelto)
Alternatives to Rivaroxaban (Xarelto) include:
Characteristics of Alternatives
These alternatives have the following characteristics:
- Direct oral factor Xa inhibitors (apixaban, edoxaban, rivaroxaban) 2, 5
- Direct thrombin inhibitor (dabigatran) 4
- Vitamin K antagonist (warfarin) 3, 5, 6
- Once or twice daily administration 2, 3
- No need for laboratory monitoring 2, 3
Advantages and Disadvantages
The advantages and disadvantages of these alternatives are:
- Advantages: rapid onset, predictable pharmacokinetics, no need for routine anticoagulation monitoring 3
- Disadvantages: lack of a reversal agent, inability to use in specific patient populations, limited experience with drug-drug and drug-disease interactions, lack of available coagulation tests to quantify their effects 3, 4