Rivaroxaban and Apixaban in NVAF

Question 1

Rivaroxaban PK

Answer 1

BA = 66% without food, 80%–100% with food; anticoagulation onset = 2-4hr; half-life = 9-13 hr

Question 2

Rivaroxaban NVAF Dose

Answer 2

20 mg once daily with meals

Question 3

Rivaroxaban NVAF Dose Adjustment

Answer 3

15 mg once daily with meals
CrCl 15–50 mL/min/1.73 m2
Dialysis

Question 4

Rivaroxaban and Apixaban Drug Interations

Answer 4

• Strong CYP3A4 and P-gp inducers
• Strong CYP3A4 and P-gp inhibitors
• Chemotherapy agents

Question 5

Rivaroxaban package label warning

Answer 5

moderate CYP3A4 and P-gp inhibitors (e.g., amiodarone, verapamil, diltiazem, erythromycin, dronedarone, cimetidine) in patients with a CrCl of 15–80 mL/minute/1.73 m2

Question 6

Converting from Rivaroxaban/Apixaban to Warfarin

Answer 6

Discontinue and begin both a parenteral anticoagulant and warfarin when the next dose of rivaroxaban/apixaban would have been taken. Discontinue the parenteral anticoagulant when INR > 2

Question 7

Converting from Rivaroxaban/Apixaban to Anticoagulants(with rapid onset) Other than Warfarin

Answer 7

Discontinue and give the first dose of the other anticoagulant (oral or parenteral; other than warfarin) when the next rivaroxaban/apixaban dose would have been taken

Question 8

Converting from Warfarin to Rivaroxaban

Answer 8

Discontinue warfarin and initiate rivaroxaban once INR < 3.0

Question 9

Converting from Anticoagulants (with rapid onset) Other than Warfarin to Rivaroxaban/Apixaban

Answer 9

Begin 0–2 hr before the next scheduled evening administration of the drug (e.g., LMWH or nonwarfarin oral anticoagulant), and do not administer the other anticoagulant. For UFH administered by continuous infusion, stop the infusion and start at the same time

Question 10

Apixaban PK

Answer 10

BA = 50%, Anticoagulation onset = 2-3 hr, half-life - 12 hr

Question 11

Apixaban NVAF Dose

Answer 11

5 mg twice daily

Question 12

Apixaban NVAF Dose Adjustment

Answer 12

2.5 mg twice daily
* Two of three criteria (age ≥ 80 yr, weight ≤ 60 kg, or SCr ≥ 1.5 mg/dL) including dialysis
* Use with strong CYP3A4 and P-gp inhibitors

Question 13

Rivaroxaban NVAF with PCI dose

Answer 13

15 mg once daily (or 10 mg once daily if CrCl was 30-50 mL/ minute/1.73 m2) plus clopidogrel 75 mg daily

Question 14

Converting from Warfarin to Apixaban

Answer 14

Discontinue warfarin and start apixaban when INR <2

Question 15

Strong CYP3A4 and P-gp inducers

Answer 15

rifampin, phenytoin, carbamazepine, St. John’s wort

Question 16

Strong CYP3A4 and P-gp inhibitors

Answer 16

protease inhibitors, itraconazole, ketoconazole, conivaptan