Name of discharging hospital:
Discharge Instruction Sheet for General Practitioners
Patient’s name
Dear Dr
Your patient has been prescribed the oral anticoagulant Xarelto® (rivaroxaban, Bayer
HealthCare Pharmaceuticals) for the treatment of DVT/PE [delete as appropriate] and the
prevention of recurrent DVT and PE. This letter provides guidance regarding the care of your
patient while they are receiving treatment with Xarelto. Please keep this letter for
your records.
Some important information about Xarelto:
 Contraindications to Xarelto include:
– Hypersensitivity
– Clinically significant active bleeding
– Lesion or condition at significant risk of major bleeding
– Concomitant treatment with any other anticoagulant agent except under circumstances
of switching
– Hepatic disease associated with coagulopathy and clinically relevant bleeding risk
including cirrhotic patients with Child–Pugh B and C
– Pregnancy and breast feeding
 Xarelto is not recommended in patients who are concomitantly receiving systemic
treatment with medications that increase Xarelto plasma concentrations and, therefore,
increase the risk of bleeding. This includes (but is not limited to) azole-antimycotics and
HIV protease inhibitors, which are both potent inhibitors of cytochrome P450 3A4 and
P-glycoprotein
 Medications that decrease Xarelto plasma concentrations such as phenytoin,
carbamazepine, phenobarbital and St John´s wort, which are strong inducers of
cytochrome P450 3A4 should be used with caution in patients taking Xarelto
 Xarelto should be used with caution in patients taking concomitant medications that may
affect haemostasis, including ASA or NSAIDs
 Xarelto should be used with caution in conditions with increased risk of haemorrhage and
is not recommended in patients with other risk factors for bleeding, including active
ulcerative gastrointestinal disease.
 Xarelto is not recommended in patients with PE who are haemodynamically unstable or
who may receive thrombolysis or pulmonary embolectomy
 Xarelto is not recommended for use in patients below 18 years of age
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Your patient was seen by Dr
(discharging physician)
Contact details
Date of discharge
Patient information
Date of hospital admission
Date of diagnosis
Presenting symptoms
Recommended duration of treatment
Additional notes
Medication plan for VTE treatment
Date and time of first Xarelto dose
Other medications
Xarelto dosing guide for the treatment of DVT and PE and prevention of
recurrent DVT and PE in adults, including those with renal impairment
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Bayer Pharma AG. Xarelto® (rivaroxaban) Summary of Product Characteristics. November 2012
*Use with caution when concomitantly receiving other medicinal products which increase rivaroxaban plasma concentrations
BID = twice daily, OD = once daily
Note: The duration of therapy should be individualised after careful assessment of the treatment benefit against the risk of
bleeding events.
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Please explain to your patient the importance of taking the anticoagulant as prescribed, while
re-emphasizing possible signs and symptoms of bleeding, and what to do in each case. Your
patient should alert you or another healthcare provider if they experience unexplained
dizziness or weakness, swelling or discomfort, sudden severe headache, bruising, bleeding
from any site (e.g. nasal, gingival or rectal), heavy menstrual flow or vaginal bleeding, pink or
brown urine, pink or black stools, coughing up blood, or vomiting blood or material that looks
like coffee grounds. A return to the emergency department may be necessary if your patient
experiences significant bleeding from any site. Please encourage your patient to discuss any
other unusual symptoms with you. The patient should be advised about the importance of
notifying any healthcare professional (medical or dental) they visit that they are taking
Xarelto.
Please be advised that your patient will be sent a follow-up appointment notification
in
days/months [delete as appropriate] to evaluate whether treatment with Xarelto
should be continued, or the dose of Xarelto changed.
For further information, please refer to the Xarelto Prescriber Aid:
https://prescribe.xarelto.com/scripts/index.php
Alternatively, the Xarelto (rivaroxaban) Summary of Product Characteristics (approved by the
European Commission), is available at:
http://www.xarelto.com/html/downloads/Xarelto-Prescribing_Information-Nov-2012.pdf
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