Rivaroksaban

Rivaroksaban, more commonly spelled rivaroxaban, is an oral anticoagulant that belongs to the class of direct oral anticoagulants (DOACs), specifically a direct inhibitor of factor Xa. The spelling rivaroksaban appears to be a misspelling of rivaroxaban; the following summarizes rivaroxaban as it is used clinically. It is approved for several indications related to prevention and treatment of thromboembolic disease.

Rivaroxaban works by inhibiting factor Xa in the coagulation cascade, both in free and clot-bound forms, which leads to a reduction in thrombin generation and clot formation. It is used to reduce the risk of stroke and systemic embolism in nonvalvular atrial fibrillation, to prevent venous thromboembolism after hip or knee replacement surgery, and to treat deep vein thrombosis and pulmonary embolism. In some settings, it is also used to reduce the risk of recurrent DVT.

Pharmacokinetics and administration follow indication- and patient-specific dosing. Rivaroxaban is taken orally and has variable absorption depending on dose and formulation; some higher-dose regimens require administration with meals to optimize absorption. It is metabolized in the liver, mainly by cytochrome P450 enzymes, and is eliminated through renal and non-renal pathways. Because of its mechanism, rivaroxaban increases bleeding risk and is contraindicated in active major bleeding and in certain patients with severe renal or hepatic impairment. It does not normally require routine coagulation monitoring, though coagulation tests can be affected and clinical assessment of bleeding is essential.

Safety and reversal: management of major or life-threatening bleeding includes holding therapy and using reversal strategies where appropriate; specific reversal agents, such as andexanet alfa, are available in some regions, along with other measures. Clinicians tailor dosing to renal function, age, weight, and bleeding risk. Regulatory status and approved indications vary by country.