Rivaroxaban (Xarelto®): A Deep Dive

What is it?

Rivaroxaban, also known as Xarelto®, is a prescribed anticoagulant medication (sometimes called a blood thinner). It’s part of a class of medications called direct oral anticoagulants (DOACs).

Rivaroxaban is approved for several uses, including:

CAD: Coronary artery disease

PAD: Peripheral artery disease

How does it work?

Rivaroxaban is a factor Xa inhibitor, meaning that it prevents clot formation by directly blocking factor Xa in the clotting cascade. The clotting cascade is the process by which the body creates blood clots and stops patients from bleeding.

“However, the clotting cascade can also cause a problem if a clot forms in an inappropriate place in the body, which can result in a stroke, heart attack, deep vein thrombosis (DVT) or pulmonary embolism (PE),” explains John Fanikos, RPh, MBA, Director of Pharmacy Services for Brigham and Women’s Hospital.

For this reason, rivaroxaban works effectively to stop clots and prevent venous thromboembolism (VTE, which includes DVT and PE) and strokes in NVAF.

What are the benefits of taking rivaroxaban?

Rivaroxaban has several benefits that set it apart from other DOACs:

  • It’s a once-daily medication that should be taken with food. (Some DOACs need to be taken twice a day.) 
    • “Many patients forget to take medication on time, which can be dangerous for patients on anticoagulants. The once-daily dose of rivaroxaban can be helpful for these patients when taking it with food at mealtimes,” said Dr. Fanikos.
  • It can be used in children ages 2 and older for VTE in a low-dose liquid form.
  • It doesn’t require routine blood tests or dietary restrictions.

What are the risks?

  • Patients on rivaroxaban have a higher risk of bleeding. Contact sports or high-risk activities (such as skiing, boxing, or wrestling) can pose a bleeding risk for people on blood thinners. Patients should consult with a doctor if they take rivaroxaban and engage in these activities.
    • However, in the event of major or life-threatening bleeding, rivaroxaban can be reversed with a medication called andexanet alfa (Andexxa®).

Safety considerations

If you take rivaroxaban, you should call your doctor immediately if you experience any symptoms of bleeding, which can include:

  • Unexpected bleeding (such as nosebleeds, bleeding in gums, or vomiting blood)
  • Heavy menstrual bleeding or bloody urine or stools
  • Dizziness, bad headaches, or weakness on one side of body

You can help further manage your bleeding risk while on rivaroxaban by: 

  • Taking your medicine as directed. You should never stop your medication or change your dosage without talking to your healthcare provider first. 
  • Telling your healthcare providers about all medicines or supplements that you take—including over-the-counter medications, natural products, and vitamins—to avoid drug interactions. 
  • Avoiding certain anti-infectives (antibiotics and/or antiviral/antifungal medications), other blood thinners (heparin, warfarin), aspirin, ibuprofen, and some seizure medications or antidepressants, unless recommended by your healthcare provider.
  • Limiting or avoiding alcohol use.
  • Making sure to talk to your healthcare provider before having any type of surgical procedure.

Pregnancy or breastfeeding considerations

Rivaroxaban is unsafe to use in pregnancy and is also not recommended for use in patients who are breastfeeding.

For more information about rivaroxaban, please see our Anticoagulant Comparison Chart!


Rivaroxaban: Drug Information. UpToDate. 2022.

Related Articles