For the past several decades, warfarin has been the go-to anticoagulant for doctors, but new treatments have recently emerged in the form of direct oral anticoagulants (DOACs). DOACs are considered more effective and safer than warfarin, especially in relation to serious bleeding episodes. These anticoagulants include apixaban, betrixaban, dabigatran, edoxaban, and rivaroxaban.

NATF is dedicated to offering readers a closer look at each DOAC in order to empower patients to make informed healthcare decisions. In this issue, NATF takes a closer look at rivaroxaban:

What is it?

Rivaroxaban, also known as Xarelto, is a blood-thinning medication that is used to treat thrombosis and non-valvular atrial fibrillation patients. It’s used for patients that are at risk for developing deep vein thrombosis (DVT) or pulmonary embolism (PE). It is also used to prevent strokes in patients who have atrial fibrillation.

How does it work?

Rivaroxaban is a factor Xa inhibitor, meaning the drug binds to a factor Xa molecule, which stops blood from clotting at a certain point in the clotting cascade. The clotting cascade is the process by which the body creates blood clots.

“When it works the way it’s supposed to, the clotting cascade stops patients from bleeding and can save lives. However, it can also cause a problem if a clot is formed in an inappropriate place in the body. It can cause stroke, heart attack, PE, and DVT,” explained John Fanikos, RPh, MBA, Director of Pharmacy Services for Brigham and Women’s Hospital. “The factor Xa inhibitors interrupt the clotting cascade, preventing the blood from clotting when it shouldn’t.”

Other factor Xa inhibitors include apixaban and edoxaban. By interrupting the clotting cascade and stopping clots from forming, these drugs help to prevent DVT, PE, and more.

Patients should take rivaroxaban with food in order to help the body absorb the medication.

What is unique about rivaroxaban?

While apixaban and edoxaban are also factor Xa inhibitors, rivaroxaban has several benefits that set it apart from other DOACs.

One benefit is its dosage. Many patients on rivaroxaban for atrial fibrillation or blood clots only have to take it once a day. This can be helpful for patients who have trouble remembering to take their medications.

“Many patients have trouble remembering to take their medications consistently. This can be dangerous for patients on anticoagulants. The once-daily dose of rivaroxaban can be helpful for some patients by simply reducing the number of times a day they need to take their medication,” explained Dr. Fanikos.

What are the risks?

Rivaroxaban has its own set of unique risks that all patients should discuss with their doctor prior to taking it. As with warfarin and the other DOAC drugs, patients on rivaroxaban are at a higher risk of bleeding. This risk is increased if a patient is taking aspirin, non-steroidal anti-inflammatory drugs, clopidogrel, selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, or other medications to treat blood clots.

Patients on rivaroxaban should call their doctor if they experience any symptoms of bleeding. These can include unexpected bleeding; such as nosebleeds, bleeding from the gums, or menstrual bleeding that is heavier than normal. Patients should also contact their doctors if they feel dizzy or weak and are experiencing headaches.

Unlike warfarin and dabigatran, rivaroxaban does not currently have a reversal drug. Doctors who prescribe anticoagulants without reversal drugs work to balance the bleeding against the higher risk of VTE and stroke.


If you would like to explore rivaroxaban as a potential treatment, you must first talk to your healthcare provider. Only your doctor knows your individual health history. They can provide you with the best input on what medications are right for you. Never change or stop taking your medication without talking to your doctor.

NATF’s Anticoagulation Comparison Chart is a great tool that you can use with your healthcare provider to discuss what anticoagulant is right for you.