Rivaroxaban (a DOAC) fully funded from 1 August 2018

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Rivaroxaban (a DOAC) fully funded from 1 August 2018

Rivaroxaban is a direct oral anti-coagulant (DOAC), generally used for the prevention of atrial fibrillation related stroke and venous thromboembolism in certain patient groups (see table 1 of Medsafe xarelto datasheet). 1,2

Rivaroxaban may be particularly useful for those patients who are unable to take or are intolerant to the currently funded treatments, warfarin or dabigatran. The 10 mg tablet will be available only for prevention of venous thromboembolism for hip and knee surgery.

For patients on dabigatran who have trouble with the twice-daily dosing for atrial fibrillation, rivaroxaban is an alternative using the 15 or 20 mg per day tablet. There is no current antidote for rivaroxaban.

DOACs are superior to warfarin for stroke/systemic embolism (have fewer haemorrhagic strokes and a significant reduction in all-cause mortality) and a trend towards a reduction in major bleeding. Avoid use in patients with CrCl <30 mL/minute. 

This Gem has been checked by Dr Laura Young Haematologist at Auckland City Hospital

References:

  1. Medsafe xarelto datasheet: CrCl 30-49 ml/min – 15mg rivaroxaban Click here
  2. NZ Formulary - see rivaroxaban Click here

Gems are chosen by the Goodfellow director Dr. Bruce Arroll to be either practice changing or practice maintaining. The information is educational and not clinical advice.

 
This Gem is supported by:
 

As published in NZ Doctor 01/08/2018