Rivaroxiban is an antithrombotic drug, which inhibits Factor Xa.
The inhibition of Factor Xa interrupts the intrinsic and extrinsic pathway of the blood coagulation cascade and inhibits the formation of thrombin. Rivaroxaban does not inhibit thrombin activated by Factor II, and has no effects on platelets.
Rivaroxiban is used for prevention of venous thromboembolism (VTE) in adult patients undergoing elective hip or knee replacement surgery.
There is no need for dose-adjustment and surveillance of the coagulation parameters during treatment with rivaroxiban.
Rivaroxiban is in comparisons found better than low molecular heparin enoxaparin.
The most frequent side effects are bleedings, which occurred in 6 % of the patients. Severe bleedings occurred in 0,6 % of the patients i.e. at the same level as patients in treatment with enoxaparin.
In knee operations the treatment is recommended for two weeks after the operation, and in hip operations the treatment is recommended for 5 weeks. In Denmark the standard-treatment with low molecular heparin has been 7 – 10 days dependent of the mobilisation i.e. treatment under hospitalisation.
In Danish Orthopaedic Society’s reference programme for hip and knee replacement surgery it is accentuated that all patients should have thrombosis prophylaxis regarding the surgical procedure. Meta-analyses based on former studies indicate that prolonged thrombosis prophylaxis with a low molecular heparin (28 – 35 days) is effective in reducing the incidence of both asymptomatic and symptomatic thromboses.
Treatment with rivaroxaban for 30 days costs 1.683,85 DKr. The treatment with low molecular heparin for 30 days costs 1.567,80-1.694,10 DKr.
IRF states that treatment with rivaroxaban is comparable with treatment with low molecular heparin. There are no comparative studies with other oral antithrombotic drugs as dabigatran-etexilat (Pradaxa), which costs 1.382,55 Dkr. for 30 days of treatment.
Xarelto was marketed the 20th of October 2008.