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Rivaroxaban (Xarelto) to Prevent Strokes

Rivaroxaban (Xarelto^®) is an anticoagulant medication. It is approved to prevent strokes in people with atrial fibrillation.¹

Rivaroxaban was approved by the US Food and Drug Administration (FDA) in November of 2011 based on results from the ROCKET-AF study that compared rivaroxaban to warfarin. The international study included more than 14,000 people with atrial fibrillation and a high risk of stroke. In the study, rivaroxaban worked as well as warfarin in preventing strokes, with a significantly lower risk of bleeding in the brain (known as intracranial hemorrhage).^2,3

Thus, rivaroxaban may be particularly beneficial to people of Asian or African descent, who have a higher risk of intracranial hemorrhage than whites.⁴

How It Works

Rivaroxaban is a direct factor Xa (pronounced “10 a”) inhibitor. It dirsupts factor Xa, which is needed to convert a protein called fibrinogen to fibrin, the major component of blood clots. By disrupting that process, rivaroxaban reduces the risk of blood clots and stroke.

As a direct factor Xa inhibitor, rivaroxaban is a Direct (or direct-acting) Oral Anticoagulant (DOAC).

Recommended Dosage

For reducing stroke risk in patients with atrial fibrillation, rivaroxaban is taken with the evening meal (to ensure absorption) at a dose of 20 mg once daily. For those with moderate to severe kidney disease, the dose is 15 mg once daily.^3,5,6,7,8

To learn more about who can and cannot take DOACs and what to know if you do, see Direct Oral Anticoagulants (DOACs).

What to Know If You Take Rivaroxaban

Here are things to know that are specific to taking rivaroxaban.

• Rivaroxaban costs more than warfarin, so you may have a higher out-of-pocket cost.
• Rivaroxaban may interact with other medications, including antifungal, antibiotic, and antiviral medications
• Medications that can increase the risk of bleeding while taking rivaroxaban include aspirin, non-steroidal anti-inflammatory drugs such as Motrin or Aleve, certain antidepressants, warfarin, clopidogrel (Plavix^®), heparin, and other medicines used to prevent or treat blood clots.
• If you need emergency surgery or have severe bleeding, your doctor can use a reversal agent to quickly stop the anti-clotting effects of rivaroxaban. The FDA approved Andexxa^®, the first reversal agent for rivaroxaban, in May of 2018.⁹
• See What to Know If You Take a DOAC for things everyone on a DOAC should know, including potential medication and supplement interactions, signs of unusual bleeding, and what to know if you are asked to stop your rivaroxaban for a procedure or surgery.

To learn more about other anticoagulant medications, see Warfarin (Coumadin), Apixaban (Eliquis), Dabigatran (Pradaxa), or Edoxaban (Savaysa/Lixiana).

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