Rivaroxaban Dosing for Acute DVT
For an adult with acute deep vein thrombosis and normal renal function, start rivaroxaban 15 mg orally twice daily with food for 21 days, then transition to 20 mg once daily with food for at least 3 months of continued treatment. 1
Initial Treatment Phase (Days 1-21)
- Administer 15 mg twice daily with food for the first 21 days to provide stronger anticoagulation when thrombus burden is highest 2, 1
- Taking the medication with food is critical—bioavailability increases from 66% to 80-100% when taken with meals 2
- No initial parenteral anticoagulation (such as enoxaparin or heparin) is required before starting rivaroxaban, making this a convenient single-drug regimen 1
Maintenance Phase (After Day 21)
- Transition to 20 mg once daily with food after completing the initial 21-day period 2, 1
- Continue this maintenance dose for a minimum of 3 months, with total duration determined by underlying risk factors for recurrence 1
- The EINSTEIN-DVT trial demonstrated non-inferiority to enoxaparin/warfarin with recurrent VTE rates of 2.1% versus 3.0% (HR 0.68; 95% CI 0.44-1.04) 1
Extended Secondary Prevention (Beyond 6 Months)
- After completing 6 months of initial therapy, consider dose reduction to 10 mg once daily for extended secondary prevention of recurrent VTE 2, 1
- The 10 mg dose can be taken with or without food, unlike the higher doses 2
- The EINSTEIN-CHOICE trial demonstrated superiority of both rivaroxaban 20 mg and 10 mg doses over placebo for extended treatment 1
Critical Dosing Pitfall to Avoid
- Never use 15 mg once daily for VTE maintenance therapy in patients with normal renal function—this underdoses patients and increases recurrence risk 2
- The 15 mg once daily dose was studied only in the PIONEER-AF trial for atrial fibrillation patients undergoing PCI, not for VTE treatment 2