This guideline advises that Rivaroxaban can now be considered for use in the treatment of proximal DVT. It is as effective as warfarin, but is more expensive. I suspect we will need to await local approval before use. It doesn’t require monitoring.
It is contraindicated with GFR < 30 and ‘very high blood pressure’ among other things. Use is normally for 3m, though may be needed for longer if there are ongoing risk factors for VTE. It hasn’t really been studied beyond 12m, so use beyond that is of uncertain effectiveness (though is allowed).
Interestingly, there is a higher risk of non-major bleeding with rivaroxaban than on warfarin, though a similar rate of major bleeding.
In patients with cancer it may be less effective than warfarin, though could still be used if the patient preferred.