Test Background Rivaroxaban is a direct oral anticoagulant (DOAC) which exerts its anticoagulant effect through its ability to directly inhibit Coagulation Factor Xa. Plasma Rivaroxaban levels are measured in mass concentration by chromogenic anti-Xa assay using drug-specific calibrators.
Recommended as an option for (NICE Guidelines 2016 – KTT16):
• Prevention of VTE after elective hip or knee replacement • Treatment and secondary prevention of DVT and/or PE • Prevention of stroke and systemic embolism in people with non-valvular AF • Prevention of adverse outcomes after acute management of ACS with raised biomarkers
DOAC monitoring is not generally required; however measurement may be useful where clearance is compromised or where patients are actively bleeding.
BCSH Guidelines (2014) Measurement of non-coumarin anticoagulants and their effects on tests of Haemostasis:
Dose Peak (mean and range) Trough (mean and range) Rivaroxaban 10 mg od 125 ng/mL (91 – 195) 9 ng/mL (1 – 38) Rivaroxaban 20 mg od 223 ng/mL (160 – 360) 22 ng/mL (4 – 96)
Peak – 3 hours post-dose
Sample Required 4.5 mL sodium citrate (pale blue top) adults 1.8 mL sodium citrate (pale blue top) paediatrics
Turnaround Time <24 hours (core hours)
Notes Please Note: Samples will be rejected if under/over-filled, clotted or haemolysed