American Board of Family Medicine (ABFM) Practice Exam

After a knee replacement, what is the recommended next step for a patient on warfarin who presents with a DVT?

1. Aspirin

2. Clopidogrel (Plavix)

3. Rivaroxaban (Xarelto)

4. Intravenous tenecteplase (TNKase)

The correct answer is: Rivaroxaban (Xarelto)

Choosing Rivaroxaban (Xarelto) as the next step for a patient on warfarin who presents with a deep vein thrombosis (DVT) after knee replacement is appropriate due to several important clinical considerations. Rivaroxaban is an oral direct factor Xa inhibitor, which provides effective anticoagulation management for DVT and can be used as an alternative to vitamin K antagonists like warfarin. In cases where a patient on warfarin develops a DVT, the primary goal is to ensure effective anticoagulation to prevent further thrombus formation while managing the existing condition. Since warfarin requires careful monitoring of INR levels and can take several days to achieve therapeutic levels, transitioning to Rivaroxaban allows for a more prompt and reliable anticoagulation management. Rivaroxaban offers the advantage of not requiring routine laboratory monitoring, which can simplify patient management in an outpatient setting. Additionally, the use of an oral factor Xa inhibitor makes it suitable for patients who may be at higher risk of complications or have difficulty with injectable anticoagulants. It is also important to consider that Rivaroxaban has established protocols for treating DVT and is often preferred in current guidelines for the management of such conditions in post-operative scenarios