Imperial Collage Healthcare


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.

Clinical Indications

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.

Reference Range

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)

Please Note: Samples will be rejected if under/over-filled, clotted or haemolysed

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