利伐沙班注意事项

Rivaroxaban is a small molecule oral anticoagulant jointly developed by Bayer and Johnson & Johnson, with the trade name Xarelto. Rivaroxaban tablets were approved by the State Food and Drug Administration in March 2009. What are the precautions for using rivaroxaban?

1. Bleeding risk: Some subgroups of patients have a higher risk of bleeding. After initiation of treatment, these patients should be monitored closely for signs of bleeding complications. This can be accomplished by regular physical examination of the patient, close observation of surgical wound drainage, and regular determination of hemoglobin. Any unexplained decrease in hemoglobin or blood pressure should prompt a search for the site of bleeding.

2. Renal damage: In patients with severe renal impairment (creatinine clearance <30mL/min), the plasma concentration of rivaroxaban may be significantly increased, leading to an increased risk of bleeding. Rivaroxaban is not recommended for patients with creatinine clearance <15 mL/min. Rivaroxaban should be used with caution in patients with creatinine clearance 15-29 mL/min. Rivaroxaban should be used with caution in patients with moderate renal impairment (creatinine clearance 30-49 mL/min) when used concomitantly with other drugs that may increase rivaroxaban plasma concentrations.

3. Liver damage: In cirrhotic patients with moderate liver damage (Child Pugh category B), the plasma concentration of rivaroxaban may be significantly increased, leading to an increased risk of bleeding. Rivaroxaban is contraindicated in patients with liver disease associated with coagulation abnormalities and clinically relevant risk of bleeding. Rivaroxaban can be used with caution in patients with cirrhosis who have moderate hepatic impairment (Child Pugh category B) and are not accompanied by coagulation abnormalities.

4. Interactions with other drugs: azole-antifungal agents (such as ketoconazole, itraconazole, voriconazole and posaconazole). Please read the instructions carefully and use it as directed by your doctor.

5. Impact on the ability to drive and use machinery: There are no studies on the impact on the ability to drive and use machinery. There have been reports of syncope and dizziness after surgery, which may affect the ability to drive and use machinery, but reports indicate that these adverse reactions are uncommon. Patients experiencing these adverse reactions should not drive or use machinery.

6. In the absence of adequate alternative anticoagulant therapy, premature discontinuation of any oral anticoagulant, including rivaroxaban, will increase the risk of thromboembolic events. In clinical trials, an increased incidence of stroke was observed during switching from rivaroxaban to warfarin in patients with nonvalvular atrial fibrillation. If rivaroxaban must be discontinued prematurely for reasons other than pathological bleeding or completion of therapy, consider administering an alternative anticoagulant.