Pharmacology · patient case question
What is the mechanism of action of RIVAROXABAN (Xarelto)?
Patient case: Mechanisms of action — candesartan, dexamethasone, rivaroxaban
Scenario: Mechanism-of-action questions on three medications from the patient's list.
Show answer and explanation
Correct answer: D. Direct factor Xa inhibitor
- A. Aspirin is the irreversible COX inhibitor, acting on platelet function rather than the coagulation cascade.
- B. Dabigatran is the direct THROMBIN (factor IIa) inhibitor.
- C. Warfarin is the vitamin K antagonist; it inhibits vitamin K epoxide reductase and reduces synthesis of factors II, VII, IX and X, and is monitored by INR.
- D. Correct. Rivaroxaban is a DIRECT ORAL ANTICOAGULANT (DOAC) that directly and reversibly inhibits FACTOR Xa, the convergence point of the intrinsic and extrinsic pathways, thereby preventing the conversion of prothrombin to thrombin.
Note: The '-XA-BAN' drugs inhibit factor XA: riva-ROXA-ban, apiXAban, edoXAban. DENTAL MANAGEMENT: for routine procedures, DO NOT stop the DOAC. Use local haemostatic measures — sutures, oxidised cellulose, tranexamic acid mouthwash — and where possible schedule so that the procedure occurs at the TROUGH level, before the next dose. Note also that INR does NOT monitor DOACs.