Summary

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• Xarelto (rivaroxaban) is indicated to reduce the risk of stroke and systemic embolism in nonvalvular atrial fibrillation and to treat deep vein thrombosis (DVT) and pulmonary embolism (PE). It is also used for the prophylaxis of DVT, venous thromboembolism in acutely ill patients, and major cardiovascular events in coronary artery disease. Additionally, Xarelto is used for pediatric patients with VTE and those requiring thromboprophylaxis after the Fontan procedure.
• This summary is based on the review of 102 systematic review(s)/meta-analysis(es). ^[1-102]
• Stroke Prevention in AF: Rivaroxaban at standard dosing has a slightly better effectiveness profile than reduced dosing (HR: 0.79 vs. HR: 0.83). In obese patients with non-valvular AF, rivaroxaban significantly reduces the risk of ischemic stroke (RR: 0.79), hemorrhagic stroke (RR: 0.61), and systemic embolism (RR: 0.73) compared to warfarin.
• Cardiovascular Outcomes in CAD: Rivaroxaban plus aspirin does not differ significantly in major adverse cardiovascular events compared to other antiplatelet strategies but reduces ischemic stroke incidence (OR: 0.49).
• Venous Thromboembolism: Apixaban is associated with a lower risk of recurrent VTE (RR: 0.77) and major bleeding (RR: 0.68) compared to rivaroxaban. Rivaroxaban also shows a reduced risk of recurrent VTE and major bleeding compared to standard care (HR: 0.56 for all-cause death).
• Atherothrombotic Events in PAD: Rivaroxaban plus aspirin significantly decreases the incidence of major adverse limb events (MALE) (pooled OR: 0.70) and stroke compared to aspirin alone.
• Standard vs. Reduced Dosing in AF: Standard dosing of rivaroxaban shows a better safety profile than reduced dosing with fewer major bleeding events.
• Comparison with Apixaban: Apixaban is linked to a significantly lower risk of major bleeding compared to rivaroxaban (RR: 0.68).
• Non-valvular AF in Obese Patients: Rivaroxaban shows greater effectiveness than warfarin in reducing stroke and embolism, with a lower risk of major bleeding (RR: 0.75).
• Elderly Patients (65+ years) with NVAF or VTE: Rivaroxaban generally has a positive or neutral effect on thrombosis but presents a mixed picture for bleeding outcomes.