What you should know about rivaroxaban?👀

Rivaroxaban is a new oral anticoagulant. It has been widely used in theprevention and treatment of venous thromboembolic disease, and stroke prevention in non-valvular atrial fibrillation. In order to use rivaroxaban more rationally, you need to know at least this knowledge.

The differences between rivaroxaban and other oral anticoagulants.

Commonly used oral anticoagulants include warfarin, dabigatran, rivaroxaban and apixaban. Among them, dabigatran, rivaroxaban, apixaban and so on. are called new oral anticoagulants (NOAC).

Warfarin exerts its anticoagulant effect mainly by inhibiting the synthesis of coagulation factors II, VII, IX and X. Because warfarin has no effect on synthetic clotting factors, its onset of action is slower.

Rivaroxaban mainly exerts its anticoagulant effect by inhibiting the activity of coagulation factor Xa and reducing the synthesis of thrombin. Since it does not affect the thrombin activity that has been generated, it has little effect on the physiological hemostatic function.

Dabigatran exerts its anticoagulant effect mainly by directly inhibiting the activity of thrombin.

Pathogenesis of pulmonary embolism and stroke.

Pulmonary embolism (PE) includes tumor embolism, air embolism, amniotic fluid embolism, fat embolism, and pulmonary thromboembolism (PTE). PTE is the most common type of PE. In clinical practice, PE is usually referred to as PTE.

Deep vein thrombosis (DVT) often occurs in the deep veins of the lower extremities or pelvis. It is the leading cause of pulmonary embolism. Once the deep vein thrombosis is dislodged. The thrombus can return to the right heart through the veins and then enter the pulmonary artery. This can cause a pulmonary embolism.

In patients with atrial fibrillation, blood tends to stagnate in the atria and form clots. Once the atrial thrombus is dislodged, it can enter the carotid artery and cause a stroke. About 20% of ischemic strokes are caused by atrial thrombus.

Clinical application of rivaroxaban

Factors such as slow blood flow, vascular endothelial injury, and blood hypercoagulability can trigger deep vein thrombosis. For example, some patients who have had a successful hip or knee replacement surgery die suddenly a few days after the procedure. This was most likely because the patient developed deep vein thrombosis after surgery. The thrombus dislodges and causes a pulmonary embolism that leads to death.

• To prevent venous thrombosis after hip or knee replacement: The first dose should be used between 6-10 hours after surgery. The recommended dose is 10 mg once a day. For hip surgery patients, the course of treatment is 35 days. For knee surgery patients, the course of treatment is 12 days.
• To treat or reduce the risk of recurrence of deep vein thrombosis and pulmonary embolism: For the first 1-21 days, 2 times a day, 15mg each time. After 22 days, 1 time a day, 20 mg each time. The course of treatment is at least 3 months.
• Reduced risk of stroke and systemic embolism in non-valvular atrial fibrillation: The recommended dose is 20 mg once daily and long-term treatment is required.

The differences between different dosage formulations of rivaroxaban.

Rivaroxaban tablets are available in three doses: 10mg, 15mg and 20mg. Rivaroxaban tablets are different from most medicines. Different doses of rivaroxaban tablets are used in different ways.

• Rivaroxaban Tablets 10mg: Food does not affect the absorption of rivaroxaban tablets 10mg. It is almost completely absorbed whether on an empty or full stomach. Its bioavailability is 80-100%.
• Rivaroxaban Tablets 15 and 20mg: Food can promote its absorption. Compared with taking the medicine on an empty stomach, the bioavailability of the medicine on a full stomach can be increased by 39%, and the peak concentration can be increased by 76%.

If the patient cannot swallow the whole tablet, rivaroxaban tablet can be crushed before taking the medicine, mix it with applesauce and take it orally immediately.

For missed doses:

• For the once-daily dose, missed doses should be made up immediately. However, the dose should not be doubled within 1 day in order to make up the dose.
• For treat or reduce the risk of recurrence of deep vein thrombosis and pulmonary embolism, the dose for the first 1-21 days requires a total daily dose of 30 mg. Therefore, if you miss a dose, you may need to take two 15mg tablets at a time.

Side effects of rivaroxaban:

The anticoagulant effect of rivaroxaban is predictable, with a wide therapeutic window, no accumulation after multiple doses, and few drug and food interactions. Therefore, routine coagulation monitoring is not required.

Its main adverse reaction is bleeding. It can present as minor bleeding, severe bleeding, or life-threatening bleeding. Rivaroxaban is rapidly absorbed, and the peak plasma concentration takes 2 to 4 hours. In severe bleeding, the time after taking the drug should be considered to determine whether gastric lavage is required.