What is the dosage of Xarelto (rivaroxaban) for a 91-year-old patient with a deep vein thrombosis (DVT) in the lower left leg?

From the Guidelines

For a 91-year-old with a lower left leg deep vein thrombosis (DVT), the recommended Xarelto (rivaroxaban) dosing regimen is 15 mg twice daily with food for the first 21 days, followed by 20 mg once daily with food for the remainder of treatment, as supported by the most recent and highest quality study 1. The total duration of therapy typically ranges from 3-6 months, though some patients may require longer treatment depending on risk factors and whether this is a first-time or recurrent DVT.

• Dose adjustment to 15 mg once daily during the maintenance phase is necessary if the patient has moderate to severe kidney impairment (creatinine clearance 15-49 mL/min) 1.
• Regular monitoring of kidney function, bleeding risk, and medication adherence is essential, especially in elderly patients.
• The patient should be advised to take the medication at the same time each day, report any unusual bleeding or bruising, and not stop the medication without consulting their healthcare provider. Xarelto works by inhibiting Factor Xa, preventing the formation of blood clots, and does not require routine blood monitoring like warfarin does, making it more convenient for many patients. The most recent guidelines from 2024 also support the use of rivaroxaban for the treatment of DVT, with a recommended dosing regimen of 15 mg twice daily for 21 days, followed by 20 mg once daily 1.
• The guidelines also emphasize the importance of regular monitoring and dose adjustment in patients with kidney impairment. Overall, the use of Xarelto (rivaroxaban) is a safe and effective treatment option for DVT in elderly patients, with a convenient dosing regimen and minimal monitoring requirements.

From the FDA Drug Label

Adults 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 dosage of Xarelto for a 91-year-old with lower left leg DVT is 15 mg or 20 mg tablets with food for the initial treatment. After at least 6 months of initial treatment, the dosage is 10 mg once daily with or without food for continued risk of recurrent DVT and/or PE 2.

From the Research

Treatment for Lower Left Leg DVT

• The provided studies do not directly address the treatment for a 91-year-old patient with lower left leg Deep Vein Thrombosis (DVT) or the dosage of Xarelto (rivaroxaban) for this specific condition 3, 4, 5, 6, 7.
• However, some studies discuss the use of rivaroxaban and apixaban in patients with renal impairment, which may be relevant for elderly patients with potential kidney function decline 3, 4, 5, 6, 7.
• A study on rivaroxaban in patients with mild renal insufficiency and verapamil coadministration suggests that the clearance of rivaroxaban may be impaired, potentially increasing the risk of bleeding 5.
• Another study comparing rivaroxaban or apixaban with warfarin in atrial fibrillation patients with stage 4-5 chronic kidney disease or on dialysis found that rivaroxaban or apixaban were associated with reduced risks of all-cause death and gastrointestinal bleeding 6.
• A systematic review and meta-analysis on the safety and efficacy of apixaban, rivaroxaban, and warfarin in end-stage renal disease with atrial fibrillation found that apixaban may have a lower risk of major bleeding and comparable risk of stroke when compared with warfarin 7.

Dosage of Xarelto

• The studies provided do not specify the dosage of Xarelto (rivaroxaban) for a 91-year-old patient with lower left leg DVT 3, 4, 5, 6, 7.
• However, the standard dosage of rivaroxaban for DVT treatment is typically 15 mg twice daily for the first 21 days, followed by 20 mg once daily 5.
• It is essential to consult the prescribing information and consider the patient's renal function, age, and other comorbidities when determining the appropriate dosage of rivaroxaban 3, 4, 5, 6, 7.