Factor Xa inhibitors
Drug Safety Update
May 2023: Direct-acting oral anticoagulants (DOACs): paediatric formulations; reminder of dose adjustments in patients with renal impairment
October 2020: Warfarin and other anticoagulants: monitoring of patients during the COVID-19 pandemic
June 2020: Direct-acting oral anticoagulants (DOACs): reminder of bleeding risk, including availability of reversal agents
July 2019: Rivaroxaban (Xarelto▼): reminder that 15 mg and 20 mg tablets should be taken with food
June 2019: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome
October 2018: Rivaroxaban (Xarelto▼) after transcatheter aortic valve replacement: increase in all-cause mortality, thromboembolic and bleeding events in a clinical trial
October 2013: New oral anticoagulants apixaban (Eliquis▼), dabigatran (Pradaxa) and rivaroxaban (Xarelto▼)- Risk of serious haemorrhage (clarified contraindications
Note: similar contraindications will also apply to edoxaban
NICE Guidance (also see drug-specific links below)
NG158: Venous thromboembolic diseases: diagnosis, management and thrombophilia testing
NG196: Atrial fibrillation: diagnosis & management
ICB Guidance
Kent and Medway ICB Position Statement and Risk Mitigation Principles for Anticoagulant Prescribing in non-valvular AF (nvAF), April 2025 (review due April 2027)
Please also refer to the Thromboembolism page under the prescribing guidelines.
Direct Oral Anticoagulants (DOACs) are recommended as first line treatment over Vitamin K antagonists (Warfarin) for treatment in newly initiated patients with non-valvular atrial fibrillation (NVAF) as per NICE NG196. Apixaban or Rivaroxaban (prescribed generically) is recommended as first line (preferred) DOAC in newly diagnosed patients with NVAF, unless contraindicated, not tolerated or clinically inappropriate. Please see above for the Kent and Medway ICB Position Statement and Risk Mitigation Principles for Anticoagulant Prescribing, for advice on cost-effective choice of DOAC.
Prescribing Notes
VTE prophylaxis following hip and knee replacement surgery - apixaban is the Trust preferred choice.
Renal impairment - renal function should be checked by calculating the creatinine clearance using Cockcroft Gault prior to initiation of these drugs. Check recommendations for each drug individually as they are different. Reassess renal function regularly as needed. Also see DOACs monitoring guidance for more information.
| Pack |
|---|
| 10 tablet |
| 20 tablet |
| 60 tablet |
| Pack |
|---|
| 56 tablet |
| 28 tablet |
| 60 tablet |
Please note Rivaroxaban tablets are the preferred cost effective option over more costly Rivaroxaban capsules.
| Pack |
|---|
| 56 tablet |
| 100 tablet |
| Pack |
|---|
| 10 tablet |
| 30 tablet |
| 100 tablet |
| Pack |
|---|
| 28 tablet |
| 42 tablet |
| 100 tablet |
| 14 tablet |
| Pack |
|---|
| 28 tablet |
| 100 tablet |
| 7 tablet |
| Pack |
|---|
| 10 tablet |
| Pack |
|---|
| 28 tablet |
| 30 tablet |
| Pack |
|---|
| 28 tablet |
| 30 tablet |
| Pack |
|---|
| 10 pre-filled disposable injection |
| Pack |
|---|
| 10 pre-filled disposable injection (2 x 5 pre-filled syringes) |
| Pack |
|---|
| 10 pre-filled disposable injection (2 x 5 pre-filled syringes) |
| Pack |
|---|
| 10 pre-filled disposable injection (2 x 5 pre-filled syringes) |
| Pack |
|---|
| 10 pre-filled disposable injection (2 x 5 pre-filled syringes) |
- On Formulary Preferred
- On Formulary Second Line
- On Formulary Third Line
- Specialist Initiation
- Secondary Care Only
- Not Approved for Formulary