Rivaroxaban (Factor Xa inhibitor)

Kylie is treated with oral rivaroxaban, which is licenced for the treatment of deep vein thrombosis and pulmonary embolism as monotherapy. She is admitted to the ward. 

24 hours later, she notices red, raised bumps on her abdomen, which cause her a lot of itching and discomfort. The urticarial rash is attributed to rivaroxaban. You recommend starting her on apixaban (factor Xa inhibitor), as it is not known to cross-react with rivaroxaban. Kylie refuses to take this drug as she is afraid to try a new drug. She tells you that her mother used to take warfarin (vitamin K antagonist, anticoagulant) for atrial fibrillation and she would like to be started on that instead. 

What advice would you give Kylie?

  • Warfarin may be commenced but LMWH is also needed initially
  • Warfarin may be commenced as an alternative to apixaban
  • It is absolutely inadvisable to commence warfarin
  • It is advisable to start aspirin rather than warfarin

Map: Kylie Brooks_ORU (1091)
Node: 20607
Score:

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