Rivaroxaban is an oral anticoagulant, and bleeding is its core risk. Patients with active bleeding and severe liver and kidney dysfunction are contraindicated or should be avoided, and identifying these conditions is a prerequisite for safe medication.

1、 Active bleeding patients

1. Clarify taboos

Patients with active and clinically significant bleeding are prohibited from using rivaroxaban. Anticoagulant therapy can worsen bleeding and be life-threatening.

2. Common types of active bleeding

Including gastrointestinal bleeding (vomiting blood, black stool), intracranial bleeding, urogenital bleeding, respiratory bleeding, and postoperative active bleeding.

3. High risk bleeding lesions

Lesions known to pose a risk of bleeding, such as active peptic ulcers, recent intracranial hemorrhage, and esophageal variceal rupture, should not be used.

4. Bleeding prone diseases

Individuals with congenital or acquired bleeding disorders such as hemophilia, platelet dysfunction, and severe thrombocytopenia are contraindicated to use rivaroxaban.

5. Recent major surgeries

Individuals who have recently undergone central nervous system surgery or ophthalmic surgery should avoid using it due to severe bleeding consequences.

6. Handling principles

If active bleeding occurs during medication, the medication should be stopped immediately and emergency medical attention should be sought to assess the bleeding site and severity. If necessary, supportive measures such as hemostasis, fluid replacement, and blood transfusion should be taken.

2、 Severe liver dysfunction patients

1. Taboo scope

Patients with severe liver dysfunction, especially those with liver disease accompanied by coagulation dysfunction and clinically related bleeding risk, should not use rivaroxaban.

2. Pathophysiological basis

The liver is an important organ for the synthesis of coagulation factors. When severe liver dysfunction occurs, the synthesis of coagulation factors decreases, and there is already a tendency for bleeding. Anticoagulants can further increase the risk.

3. Child Pugh grading reference

Child Pugh B and C grade cirrhosis patients, especially C grade, should generally avoid using rivaroxaban.

4. Moderate liver dysfunction

Patients with moderate liver dysfunction should use with caution. The decision should be made by a doctor after assessing the risk of bleeding and thrombosis, and if necessary, adjusting the plan or choosing other anticoagulants.

5. Monitoring recommendations

Patients with liver dysfunction should be closely monitored for liver function, coagulation indicators, and bleeding symptoms during medication, and any abnormalities should be promptly addressed.

3、 Severe renal insufficiency patients

1. Renal function affects drug clearance

Part of rivaroxaban is excreted through the kidneys. When renal function declines, drug clearance slows down, blood drug concentration increases, and the risk of bleeding increases.

2. Reference creatinine clearance rate

Patients with creatinine clearance rates below 30mL/min should use rivaroxaban with caution. The specific decision to discontinue and adjust the dosage should be based on indications and physician evaluation.

3. Dialysis patients

The safety and efficacy data of rivaroxaban for hemodialysis patients are limited, and it is usually not recommended to use it or individualized treatment under the guidance of a specialist.

4. Attention for elderly patients

Elderly patients often have physiological decline in renal function. Even if creatinine levels are normal, creatinine clearance rate should be evaluated to avoid drug accumulation.

5. Regular monitoring

During medication, renal function should be monitored regularly, especially when combined with hypertension, diabetes, heart failure and other diseases that may affect renal function.

6. Dose adjustment

For certain indications, patients with renal insufficiency may need to adjust the dosage. Patients are not allowed to add or remove items on their own and must follow medical advice.