WARNINGS: (A) DISCONTINUING XARELTO IN PATIENTS WITH NONVALVULAR ATRIAL FIBRILLATION INCREASES RISK OF STROKE, (B) SPINAL/EPIDURAL HEMATOMA
A. DISCONTINUING XARELTO IN PATIENTS WITH NONVALVULAR ATRIAL FIBRILLATION
Discontinuing XARELTO places patients at an increased risk of thrombotic events. An increased rate of stroke was observed following XARELTO discontinuation in clinical trials in atrial fibrillation patients. If anticoagulation with XARELTO must be discontinued for a reason other than pathological bleeding, consider administering another anticoagulant [see Dosage and Administration, Warnings and Precautions, and Clinical Studies].
B. SPINAL/EPIDURAL HEMATOMA
Epidural or spinal hematomas have occurred in patients treated with XARELTO who are receiving neuraxial anesthesia or undergoing spinal puncture. These hematomas may result in long-term or permanent paralysis. Consider these risks when scheduling patients for spinal procedures. Factors that can increase the risk of developing epidural or spinal hematomas in these patients include:
use of indwelling epidural catheters
concomitant use of other drugs that affect hemostasis, such as non-steroidal anti-inflammatory drugs (NSAIDs), platelet inhibitors, other anticoagulants
a history of traumatic or repeated epidural or spinal punctures
a history of spinal deformity or spinal surgery
[see Warnings and Precautions (5.2, 5.3) and Adverse Reactions].
Monitor patients frequently for signs and symptoms of neurological impairment. If neurological compromise is noted, urgent treatment is necessary [see Warnings and Precautions].
Consider the benefits and risks before neuraxial intervention in patients anticoagulated or to be anticoagulated for thromboprophylaxis [see Warnings and Precautions].
Rivaroxaban, a factor Xa inhibitor, is the active ingredient in XARELTO Tablets.
Reduction of Risk of Stroke and Systemic Embolism in Nonvalvular Atrial Fibrillation
XARELTO (rivaroxaban) is indicated to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation.
There are limited data on the relative effectiveness of XARELTO and warfarin in reducing the risk of stroke and systemic embolism when warfarin therapy is well-controlled [see Clinical Studies].
Prophylaxis of Deep Vein Thrombosis
XARELTO (rivaroxaban) is indicated for the prophylaxis of deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE) in patients undergoing knee or hip replacement surgery.
Published Studies Related to Xarelto (Rivaroxaban)
Relationship between time in therapeutic range and comparative treatment effect
of rivaroxaban and warfarin: results from the ROCKET AF trial. 
CONCLUSIONS: The treatment effect of rivaroxaban compared with warfarin for the
Outcomes of temporary interruption of rivaroxaban compared with warfarin in
patients with nonvalvular atrial fibrillation: results from the rivaroxaban once
daily, oral, direct factor Xa inhibition compared with vitamin K antagonism for
prevention of stroke and embolism trial in atrial fibrillation (ROCKET AF). 
CONCLUSIONS: TI of oral anticoagulation is common and is associated with
Efficacy and safety of rivaroxaban compared with warfarin in patients with
peripheral artery disease and non-valvular atrial fibrillation: insights from
ROCKET AF. 
CONCLUSION: Patients with PAD in ROCKET AF did not have a statistically
Rivaroxaban versus warfarin in Japanese patients with nonvalvular atrial
fibrillation in relation to the CHADS2 score: a subgroup analysis of the J-ROCKET
AF trial. 
CONCLUSION: This subanalysis indicated that the safety and efficacy of
Net clinical benefit of rivaroxaban versus warfarin in Japanese patients with
nonvalvular atrial fibrillation: a subgroup analysis of J-ROCKET AF. 
compared with warfarin in Japanese patients with AF... CONCLUSION: Analysis of the NCB supports that rivaroxaban therapy provides
Clinical Trials Related to Xarelto (Rivaroxaban)
Explore the Efficacy and Safety of Once-daily Oral Rivaroxaban for the Prevention of Cardiovascular Events in Subjects With Nonvalvular Atrial Fibrillation Scheduled for Cardioversion [Recruiting]
A study for patients with abnormal heart rhythm (atrial fibrillation) who need to undergo
cardioversion (procedure to restore normal heart rhythm). The study will compare patients
assigned randomly (like flipping a coin) to either Rivaroxaban or vitamin K antagonist
(VKA). The study will measure common medical outcomes for this type of patient such as
bleeding and stroke.
Exploring the Efficacy and Safety of Rivaroxaban to Support Elective Percutaneous Coronary Intervention [Recruiting]
Balloon angioplasty (Percutaneous Coronary Intervention (PCI)) is commonly used to treat
patients with obstructive coronary artery disease (CAD). Although PCI is highly effective
for the management of CAD, it can potentiate an existing prothrombotic state around lesion
areas. A certain level of anticoagulation is required to perform planned PCI safely and to
minimize the periprocedural risk of thrombosis and its attendant complications, including
myocardial ischemia and infarction (heart attack). Many different anti-thrombotic regimens
have been investigated and are currently in use. The aim of this study is to explore whether
Rivaroxaban, as compared to unfractionated heparin, on the background of standard dual
antiplatelet therapy, can effectively suppress thrombosis and related adverse ischemic
events, upon balloon inflation and stent expansion, during elective PCI, without increasing
bleeding. The treatment assignment will be done in a semi-blinded design, eg, no blinding
for randomization either to Rivaroxaban (one of the three arms) or the control (UFH) group.
However, all will be blinded for the treatment dose of rivaroxaban (either 10mg or 20
mg).The 10 mg rivaroxaban plus 50 IU UFH arm will not be blinded.
Study to Observe Safety of Xarelto in VTE Prophlylaxis After Elective TKR (Total Knee Replacement) or THR (Total Hip Replacement) [Not yet recruiting]
A Prospective Pharmacodynamic Study of Rivaroxaban [Recruiting]
The ability to explain bleeding or clotting complications in patients treated with
rivaroxaban remains challenging. In addition, there is limited data on how coagulation tests
perform in patients treated with therapeutic doses of rivaroxaban. Predicted responses of
coagulation tests to therapeutic doses of rivaroxaban may be helpful in better understanding
abnormal responses to rivaroxaban. The purpose of the study is to define a therapeutic
reference range for peak and trough coagulation tests in patients taking FDA approved doses
of rivaroxaban and to determine which tests may be most clinically useful for monitoring
Xarelto for Prevention of Stroke in Patients With Atrial Fibrillation [Recruiting]
This is an international observational study in patients with non-valvular atrial
fibrillation who are prescribed rivaroxaban under routine treatment conditions to prevent
stroke or non-central nervous system systemic embolism.
Reports of Suspected Xarelto (Rivaroxaban) Side Effects
Pulmonary Embolism (440),
Deep Vein Thrombosis (310),
Gastrointestinal Haemorrhage (194),
Cerebrovascular Accident (112),
Haemoglobin Decreased (111),
Oedema Peripheral (105),
Haemorrhage Intracranial (94), more >>
Page last updated: 2015-08-10