New Oral Anticoagulants – Xarelto ® (rivaroxaban)

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Xarelto ® in Long-Term Care

For decades warfarin (Coumadin) was the only available oral anticoagulant on the market.  Its use is complicated by a long list of drug interactions and requirements for frequent lab monitoring.  Even under ideal situations, maintaining warfarin patients within the goal INR is challenging.  In the past few years several new anticoagulant medications have come to market with fewer drug interactions and without the requirement for routine lab monitoring.  While these agents are safer in some ways, they are still high risk medications that can result in serious adverse events, including bleeding.  Errors in dosing, duration, and administration can put our residents at risk.  With these medications being ordered more frequently it is important to review current recommendations for use.

Xarelto ® (rivaroxaban) Approved Indications and Dosages:

Non-valvular A.Fib. – Stroke and embolism prevention:  20mg PO daily

DVT or PE Treatment: 15 mg PO twice daily with food for the first 21 days, then 20 mg PO once daily with food for a total of 6 months

DVT or PE Prevention in patients previously treated: 20 mg PO once daily with food at approximately the same time each day

DVT prevention post hip/knee surgery: 10 mg PO once daily for 12 days after knee replacement surgery or for 35 days after hip replacement surgery.

Administration: 15mg and 20mg tablets should be taken with food, the 10mg tablets can be taken with or without food.  All tablet strengths can be crushed.

Dose adjustment for elderly?

In residents with A.fib. and CrCl 15-50ml/min the dose should be 15mg daily (this will be most of our elderly residents).  Other indications: No dosage adjustments but avoid use if CrCl<30ml/min.

Challenge yourself to know the names and dosages of new oral anticoagulants.  Ensure an accurate indication (diagnosis) is entered into your electronic health record.  Utilize drug information resources to double check that the dose and duration are appropriate.  Ask your AlixaRx Clinical Pharmacist for additional guidance on the use of these agents, we love drug information questions!

Don’t miss a review of Eliquis® (apixaban) in the next addition of From the Front Lines.

References: Clinical Pharmacology accessed 5/10/16.  Available at:

This article was originally published in our monthly issue of From the Front Lines – a monthly publication that shares best practices and medication-related challenges faced by “front line” staff in long-term care and post-acute (LTCPAC) facilities.

>>> From the Front Lines – June 2016 <<<