Search results for:

rivaroxaban

rivaroxaban
Brand names: Xarelto
Form Strength
TABLET, ORAL 2.5 mg; 10 mg; 15 mg; 20 mg
Display Direct Factor Xa Inhibitors Class: 20120414
High Alert Drug : Policy
Medication comments:

Note: Clinical trials evaluating safety and efficacy utilized the Cockcroft-Gault formula with the use of actual body weight (weight range of patients enrolled in clinical trials: 33 to 209 kg) (data on file; Janssen Pharmaceuticals Inc 2012).
High Alert Drug: Factor Xa inhibitors
 • Nurses and pharmacists verify dose and that patient is not on another anticoagulant prior to administration.
 • Two RNs independently verify dose prior to administration if the dosing requires manipulation (i.e. drawing up a portion of a vial, or giving a portion of a syringe}.
 • Anticoagulation comparison chart available on nursing units for reference.
 • Pharmacists/nurses provide patient education for oral anticoagulants.
 • Pharmacists monitor for appropriate dosing, labs, and prevention of adverse events.
 • Reversal agents and order sets for oral anticoagulants
Anticoagulant / Antiplatelet Stoppage For Procedures
generic (Brand) Dept. Procedure Type
(hover over entry for examples)		 Stop Medication Prior To Procedure Restart after:
rivaroxaban
(Xarelto)		 Anesthesia High-risk 3 days Restart after 24 hours
Intermediate-risk 3 days Restart after 24 hours
Low-risk Requires shared assessment and risk stratification Restart after 24 hours
Patients with high risk of bleeding (eg, old age, history of bleeding tendency, concurrent uses of other anticoagulants/antiplatelets, liver cirrhosis or advanced liver disease, and advanced renal disease) undergoing low- or intermediate-risk procedures should be treated as intermediate or high risk, respectively.
Radiology
 Invasive Procedures 3 days (Hold time may need to be extended with impaired renal function)
Paracentesis/Thoracentesis 24 hours (Hold time may need to be extended with impaired renal function)
Surgery High-risk 4 doses Restart after 2-3 days
Low-risk 2 days Restart after 2-3 days
Enteral Drug Administration notes.
Generic
(Brand)		 Comments and Considerations Recommendations for Administration with Enteral Nutrition
rivaroxaban
(Xarelto)		 Exposure to drug reduced with release in distal small intestine. Suggest no dose adjustment if enteral tube ends in stomach. Suggest using alternative anticoagulant if enteral tube ends distal to stomach.
2023 American Geriatrics Society Beers Criteria® for potentially inappropriate medication use in older adults.
Medication: rivaroxaban (Xarelto)
Criteria 1: Potentially inappropriate medication use in older adults. (Table 2)
Comments When selecting among DOACs and choosing a dose, pay special consideration to kidney function (see Table 6), indication, and body weight.
Drug(s) for long-term treatment of nonvalvular atrial fibrillation or venous thromboembolism (VTE)
Rationale At doses used for long-term treatment of VTE or nonvalvular atrial fibrillation, rivaroxaban appears to have a higher risk of major bleeding and GI bleeding in older adults than other DOACs, particularly apixaban.
rivaroxaban may be reasonable in special situations, for example when once-daily dosing is necessary to facilitate medication adherence. All DOACs confer a lower risk of intracranial hemorrhage than warfarin.
Recommendation Avoid for long-term treatment of atrial fibrillation or VTE in favor of safer anticoagulant alternatives.
See also criteria on warfarin (Table 2) and dabigatran (Table 4) and comment above regarding the choice between warfarin and DOACs and among DOACs.
 Quality of evidence: Moderate, Strength of Recommendation: Strong
 
Criteria 5: medications that should be avoided or have their dosage reduced with varying levels of kidney function in older adults. (Table 6)
CrCl (mL/min) at which action is required <50
Rationale Lack of efficacy or safety evidence in people with CrCl <15 mL/min; limited evidence for CrCl 15-30 mL/min.
Recommendation Avoid if CrCl <15 mL/min.
Reduce the dose if CrCl is 15-50 mL/min following manufacturer dosing recommendations based on indication-specific dosing.
 Quality of evidence: Moderate, Strength of Recommendation: Strong
Last updated: Sep. 19, 2025
UpToDate Lexidrug

Pharmacy Contact Info:

Main Inpatient Pharmacy: ext 4599, 3503
Fax: 704-878-7283

Director of Pharmacy - Randi Raynor, PharmD: ext 4501
Clinical Coordinator - Laura Rollings, PharmD: ext 4597
Pharmacy Informaticist - Stephen Pringle, PharmD: ext 7645
Pharmacy Technician Supervisor - Amy Wingler, CPhT: ext 7385
Pharmacy Automation Coordinator (Omnicell) - Melissa Fulford, CPhT: ext 3556



This site is intended for the staff of Iredell Health System. While others may view accessible pages, Iredell Health System makes no warranty, express or implied, as to the use of this information outside of Iredell Health System. The content of this policy and procedure document serves as guidance to the delivery of quality patient care. Care providers are expected to exercise critical thinking and situational awareness skills, and in specific situations to take such action as is necessary for the delivery of quality patient care.
Copyright © 2025 Rpharmy, LLC ­ All Rights Reserved