Rivaroxaban
An oral direct factor Xa inhibitor for stroke prevention in atrial fibrillation, venous clots, and coronary or leg artery disease.
Drug card
- How it works
- Binding factor Xa directly, so less thrombin is made
- Used for
- Preventing stroke in nonvalvular atrial fibrillation
- Treating and preventing deep vein thrombosis
- Treating pulmonary embolism
- With aspirin, in coronary or peripheral artery disease
- Known for
- Bleeding
- Its name
- -xaban means a direct factor Xa inhibitor
Study it as a flashcard, and it comes back before you forget it.
Mechanism of action
How does rivaroxaban work?
An oxazolidinone that selectively blocks free factor Xa and prothrombinase activity without needing antithrombin, so less thrombin is generated. About a third of a dose leaves unchanged in urine; the rest is metabolized by CYP3A4/5 and CYP2J2, and P-gp and BCRP transport it. Its higher-strength tablets are taken with food.
Like other direct factor Xa inhibitors: They bind factor Xa themselves, with no need for antithrombin, and block it both free in the blood and inside the prothrombinase complex. Less prothrombin is converted to thrombin, so less fibrin is laid down and clots grow less. They have no direct effect on platelets, but they reduce the platelet aggregation that thrombin would trigger.
Uses
What is rivaroxaban used for?
- Preventing stroke in nonvalvular atrial fibrillation
- Treating and preventing deep vein thrombosis
- Treating pulmonary embolism
- With aspirin, in coronary or peripheral artery disease
Side effects
Side effects of rivaroxaban
- BleedingKnown forSerious
- Spinal or epidural hematoma after spinal proceduresSerious
- Clots and stroke if stopped earlySerious
- Jaundice and hepatitisSerious
- Low platelet count
- AgranulocytosisSerious
- AnaphylaxisSerious
- AngioedemaSerious
- Stevens-Johnson syndrome and DRESSSerious
- Kidney injury (anticoagulant-related nephropathy)Serious
- Itching
- Abdominal pain
Known for marks what an exam expects you to know it for.
Watch for
Cautions and what sets it apart
- Avoid in moderate or severe liver impairment (Child-Pugh B or C) and in liver disease with a clotting disorder.
- Avoid when creatinine clearance is below 15 mL/min, and stop it if acute kidney failure develops.
- Avoid with drugs that both block P-gp and strongly block CYP3A (ketoconazole, ritonavir) or induce them (rifampin, carbamazepine).
- Spinal or epidural procedures (boxed warning): a hematoma can cause long-term or permanent paralysis.
Good to know: Also licensed, together with aspirin, to lower the risk of heart attack, stroke and limb events in coronary or peripheral artery disease.
Remember it
A way to remember it
Xa marks the spot: these drugs go straight for factor Xa, with no antithrombin needed.
Heparins reach factor Xa only through antithrombin. These drugs bind factor Xa themselves, both free and inside the prothrombinase complex, so less thrombin is made.
Written for biofideX
Its name
-xaban means direct factor Xa inhibitor
Rivaroxaban, apixaban and edoxaban are taken by mouth and block factor Xa directly. Fondaparinux (-parinux) also targets factor Xa, but indirectly.
- Every drug name stem
Its class
Direct factor Xa inhibitors
Easily mixed up with heparins, direct thrombin inhibitors and vitamin K antagonists.
Sources
Checked against
Written for biofideX in plain words, after checking these references:
For learning pharmacology, not for treatment decisions: no doses are given, and a prescriber, pharmacist or the product's own label is the word on any one patient. Spotted a mistake? Tell us and we'll correct it.
Blood clots and cholesterol
Rivaroxaban is one of 19 drugs practiced together here: their classes, how they work, what they treat and what they're known for.
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