Drug General Information (ID: DDIH0O5MRZ)
Drug Name			Rivaroxaban		Drug Info		Desirudin		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Anticoagulants/Factor Xa Inhibitors				Anticoagulants
Structure

Mechanism of Rivaroxaban-Desirudin Interaction (Severity Level: Major)
Increased risk of bleeding Click to Show/Hide Mechanism Graph
Drug Name		Rivaroxaban				Desirudin
Mechanism		Risk of bleeding Anticoagulant				Risk of bleeding Anticoagulant
Key Mechanism Factor 1
		Factor Name		Bleeding
		Factor Description		Patients may be at risk for bleeding when the outcome of a disease or disease treatment confounds the standard mechanisms for maintaining hemostasis. Signs or symptoms of abnormal bleeding include: bleeding that takes a long time to stop (including nosebleeds, bleeding gums, bleeding from cuts and abrasions, and menstrual bleeding); severe unexplained bruising, or bruising that becomes larger; blood in the urine or stool, etc.
Mechanism Description		Increased risk of bleeding by the combination of Rivaroxaban and Desirudin

Recommended Action
Management		Due to increased bleeding risk, the use of rivaroxaban with other anticoagulants should generally be avoided except during therapeutic transition periods where patients should be observed closely. Patients should be routinely evaluated for signs and symptoms suggesting blood loss such as a drop in hemoglobin and/or hematocrit, hypotension, or fetal distress (in pregnant women). In patients undergoing neuraxial intervention, the use of rivaroxaban should be approached with caution and only after thorough assessment of risks and benefits. Besides bleeding complications, patients should also be monitored frequently for signs and symptoms of neurologic impairment such as midline back pain, sensory and motor deficits (numbness or weakness in lower limbs), and bowel or bladder dysfunction.

References
1	Product Information. Xarelto (rivaroxaban). Bayer Inc, Toronto, IA.