A 44-year-old woman with deep vein thrombosis has moderate renal impairment (creatinine clearance 35 ml/min) and has completed 3 weeks of rivaroxaban. What is the most appropriate rivaroxaban dose for this patient?

• A. 15 mg OD
• B. 20 mg OD
• C. 10 mg OD
• D. 30 mg OD

Answer: (A)

The concept being tested is how rivaroxaban is dosed for DVT as you move from the initial treatment phase to maintenance, and how renal function influences that dosing.

For acute DVT, rivaroxaban is given as 15 mg twice daily with food for 21 days, then 20 mg once daily with food. In a patient with moderate renal impairment (creatinine clearance around 35 mL/min), the maintenance dose after the initial 21 days remains 20 mg once daily with food; moderate renal impairment does not require lowering the maintenance dose in this scenario. Therefore, after completing 3 weeks, the appropriate dosing is 20 mg once daily with meals.

Options that propose 15 mg once daily, 10 mg, or 30 mg would not align with the standard maintenance regimen for this level of renal function.