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Rivaroxaban vs. Dabigatran

Instructor: Artem Cheprasov

Artem has a doctor of veterinary medicine degree.

This lesson is going to go over some of the differences between rivaroxaban and dabigatran. You'll learn what they are, how they work, and which patients they are (or aren't) intended for.

Rivaroxaban vs. Dabigatran

Rivaroxaban and dabigatran are two blood thinners used for pretty much the same purpose. They're used to treat or prevent deep vein thrombosis, pulmonary emboli, and the risk of stroke due to nonvalvular atrial fibrillation. But they do have their differences. This lesson is going to go over some of them.

Names, Pharmacology, & Administration

Names

Let's start with some basic differences. You should be familiar with their major brand names, since patients may be more familiar with these than the generic names. Dabigatran is better known as Pradaxa while rivaroxaban is best known as Xarelto.

Pharmacology

Although both are anticoagulants, they don't work to prevent clot formation in the same exact way. Dabigatran prohibits clot formation by inhibiting thrombin while rivaroxaban prohibits clot formation by inhibiting factor Xa.

Dabigatran peaks in plasma 1 hour after administration while rivaroxaban takes at least 2 hours to peak after administration.

Administration

Both of these drugs are rapidly absorbed, and both can be taken without food. However, it's recommended that doses of rivaroxaban greater than or equal to 15 mg/day be taken with food.

Dabigatran capsules should not be broken or chewed as this can massively increase its absorption and thus lead to serious side effects. On the flip side, rivaroxaban tablets can be crushed and mixed with food if the patient has trouble swallowing the tablets whole.

Contraindications, Side Effects, & Other Considerations

Contraindications

Both rivaroxaban and dabigatran have a couple of similar contraindications. A known hypersensitivity to the drug or any other ingredient in the dosage form is one. Active, major bleeding is another one. Dabigatran has another contraindication, however: mechanical prosthetic heart valves. Canadian and other international labeling outlines other contraindications not found in the U.S. for both of these medications, such as some forms of liver disease for rivaroxaban and severe kidney disease for dabigatran among many others.

Side Effects

The adverse reactions of these medications are, in general, similar in nature. However, it appears that rivaroxaban is more likely to lead to major bleeding events than dabigatran.

Pregnancy & Breastfeeding

There are no good studies about the safety of using either drug in pregnant women. Thus, both carry a pregnancy category of C, which means they should be used with caution and only if the benefits outweigh the risks. The same consideration must be applied to nursing mothers as it is unknown how the drug affects a nursing infant.

Race

It appears that healthy Japanese individuals have higher exposures to rivaroxaban than other Asian ethnic groups. However, when corrected for body weight, these increased exposures are reduced.

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