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Briefing note: rivaroxaban (Xarelto)

What is rivaroxaban used for?

Rivaroxaban is a blood-thinning medicine used to prevent atherothrombotic events (problems caused by blood clots and hardening of the arteries) after an acute coronary syndrome (ACS). Acute coronary syndrome is a group of conditions that are associated with actual or possible heart damage due to poor blood supply. It includes unstable angina (a severe type of chest pain) and heart attack.

How does it work?

Rivaroxaban is a blood-thinning medicine (anticoagulant) used to prevent harmful blood clots. It works by blocking Factor Xa, which is an important component of blood clotting. It is taken as a tablet twice daily.

What has SMC advised?

SMC has not recommended rivaroxaban co-administered with aspirin alone or with aspirin plus clopidogrel or ticlopidine, for the prevention of atherothrombotic events in adult patients after an ACS with elevated cardiac biomarkers.

What is the evidence to support this advice?

  • A study showed that rivaroxaban in addition to standard care significantly reduced the occurrence of death from cardiovascular causes, myocardial infarction (MI), or stroke, compared to standard care alone.
  • An economic analysis compared rivaroxaban in combination with standard care with standard care alone. Standard care was assumed to be aspirin with or without clopidogrel. However, there were concerns that an economic analysis comparing rivaroxaban with a current commonly used comparator medicine combination in NHSScotland (aspirin with ticagrelor) did not find rivaroxaban to offer value for money.

SMC has not recommended rivaroxaban for use in NHSScotland because the balance of costs and benefits meant it was not considered to offer value for money.