Rivaroxaban: other medicine options
Rivaroxaban (Xarelto) may not be suitable for some people (see Who should not take rivaroxaban). If rivaroxaban is not suitable for you, your doctor will prescribe another anti-clotting medicine according to your medical condition, your individual situation and lifestyle.
Rivaroxaban is a fairly new anticoagulant (a type of anti-clotting medicine), so its long-term side effects are still being understood. For this reason, some doctors are more likely to prescribe other anticoagulant medicine they are more familiar with — such as warfarin (Coumadin, Marevan) for atrial fibrillation.
If you are already taking warfarin to prevent blood clots, and your INR is stable, there is little or no benefit in switching to rivaroxaban or another anticoagulant medicine (e.g. dabigatran or apixaban).
If you would like to know more about your treatment options or if you have any questions or concerns about your medicines, always speak to your doctor or pharmacist.
Other anti-clotting medicines
Other anti-clotting medicines include:
- warfarin (Coumadin, Marevan)
- aspirin (e.g. Astrix, Cartia, Solprin)
- apixaban (Eliquis)
- dabigatran (Pradaxa)
- enoxaparin (Clexane)
- dalteparin (Fragmin)
- fondaparinux (Arixtra).
To make sure that you are taking the correct dose of warfarin and that it is working safely and effectively in your body, you must have regular blood tests. The International Normalised Ratio, or INR blood test checks how long it takes for your blood to clot. Find out more about the INR test.
Your INR can be affected by many other medicines and some foods. If you take warfarin, you will need to eat a consistent diet. Find out more about warfarin, diet and warfarin and warfarin’s side effects and interactions.
Apixaban and dabigatran
Like warfarin and rivaroxaban (Xarelto), apixaban (Eliquis) and dabigatran (Pradaxa) are anti-clotting medicines called anticoagulants. These medicines can be used to prevent a stroke in people with atrial fibrillation and they are also used to prevent harmful clots from forming in the body.
Unlike warfarin, there is currently no equivalent of the INR blood test to monitor the effect of rivaroxaban, dabigatran or apixaban on blood clotting, or to inform any dose changes.
Some people will prefer not to have ongoing blood tests. For others, the regular INR blood tests that are needed to monitor how well warfarin is working may be reassuring, since it is an easy way to tell if you are at risk of bleeding, and if a dose change is required.
As with all anticoagulants, bleeding is also the main side effect of dabigatran, apixaban and rivaroxaban. However, unlike warfarin there is currently no specific antidote for dabigatran, apixaban or rivaroxaban to stop bleeding. So if you do have a serious bleed while you are taking one of these medicines, it may take longer to treat.
Apixaban and dabigatran are subsidised by the Pharmaceutical Benefits Scheme (PBS) for preventing blood clots after hip and knee replacement surgery, for preventing blood clots recurring in people who have had a deep vein thrombosis (DVT) or pulmonary embolism (PE) before, and for preventing stroke in people with atrial fibrillation.
Aspirin is commonly only given to people with atrial fibrillation who are younger than 65 years of age, and who have no other risk factors for stroke. It is not as effective for people at high risk of stroke.
Find out more about aspirin.
Injectable anti-clotting medicines
Injectable anti-clotting medicines are commonly used to prevent harmful blood clots from forming after hip and knee replacement surgery — particularly enoxaparin (Clexane) and dalteparin (Fragmin), which are low molecular weight heparins. Another injectable medicine called fondaparinux (Arixtra) is also available.
Enoxaparin has been available for a few years, and is the standard treatment for preventing clots after hip or knee replacement surgery. However, as enoxaparin is given as an injection, rivaroxaban may be more convenient for some people because it is taken by mouth.
Find out more about rivaroxaban
- Rossi S, ed. eAMH [online]. Australian Medicines Handbook, January 2013. www.amh.net.au (accessed June 2013).
- Cardiovascular Expert Group. Therapeutic guidelines: cardiovascular. Therapeutic Guidelines Ltd; 2013. www.tg.org.au (accessed June 2013).
- NPS Medicine Update, April 2010. Rivaroxaban (Xarelto) for preventing blood clots after hip or knee replacement surgery
- NPS Medicine Update, December 2012. Rivaroxaban (Xarelto) for preventing stroke in people with atrial fibrillation
- Therapeutic Goods Administration. Medicines Safety Update No. 5; 2010. Rivaroxaban (Xarelto) - an overview of adverse event reports. www.tga.gov.au/hp/msu-2010-05.htm