FormWeb • rivaroxaban

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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

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)
	Radiology	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
	Surgery	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.

Last updated: Apr. 17, 2024

Black Box Warnings Premature discontinuation; spinal/epidural hematomas

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

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