Rivaroxaban
Brand names: Xarelto
Class: 🩸 Anticoagulants & Antiplatelets
The AANP exam tests rivaroxaban as a once-daily DOAC with a specific food rule. It directly inhibits Factor Xa and is approved for non-valvular AFib stroke prevention, treatment and prevention of VTE, and post-surgical VTE prophylaxis. The 15 mg and 20 mg doses must be taken with the largest meal of the day to ensure adequate absorption — a counseling point candidates miss. Like other DOACs, no routine monitoring is required, but renal function dictates dose adjustments. Andexanet alfa is the reversal agent. Rivaroxaban is contraindicated in mechanical heart valves and in moderate-to-severe mitral stenosis — both still require warfarin. Avoid combining with strong CYP3A4 and P-gp inhibitors or inducers.
✅ Indications
A-fib stroke prevention, VTE treatment + prevention, post-surgical VTE prophylaxis.
⚙️ Mechanism of Action
Direct factor Xa inhibitor.
📏 Dosing
20 mg PO daily WITH FOOD (a-fib, VTE maintenance). 15 mg BID × 21 days acute VTE, then 20 mg daily.
🚫 Contraindications
Active bleeding, mechanical heart valves, mod-severe mitral stenosis, pregnancy.
⚠️ Adverse Effects
Bleeding (more GI bleed vs apixaban), anemia.
🔬 Monitoring
Annual CBC, renal function, LFTs.
💎 Board Pearls
- 🍽️ Take 20 mg dose WITH FOOD (↑ bioavailability) — 15 mg or lower doses don't require food.
- 💊 Once-daily dosing (vs apixaban BID) — adherence advantage.
- 🆘 Reversal: andexanet alfa.
- ⚠️ More GI bleeding than apixaban in head-to-head comparisons.
Practice Questions
An adult patient is being counseled on rivaroxaban 20 mg PO daily for long-term anticoagulation after a DVT. Which of the following instructions is MOST important to convey?
Related Drugs in This Class
- Warfarin — Coumadin, Jantoven
- Apixaban — Eliquis
- Aspirin — Bayer, Ecotrin
- Clopidogrel — Plavix
Sources
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