Xarelto (Rivaroxaban): How It Works and What to Expect

• Xarelto is a prescription-only direct oral anticoagulant (DOAC), or blood thinner, that is more targeted than older blood thinners. It works by specifically blocking factor Xa, a key protein in the blood clotting process.
• Use in Adults: Xarelto is prescribed to reduce the risk of blood clots in various conditions:
  • Atrial fibrillation (AFib) not caused by a heart valve problem
  • Deep vein thrombosis (DVT) and pulmonary embolism (PE)
  • Clot prevention after hip or knee replacement surgery
  • Hospitalized patients at risk of blood clots
  • Coronary artery disease (CAD) or peripheral artery disease (PAD)
• Use in Children
  • From birth to under 18 years old to treat existing blood clots or reduce the risk of new clots
  • Children aged 2 years and older with congenital heart disease after the Fontan procedure.
• Never stop taking Xarelto without speaking to a healthcare provider, as suddenly stopping can increase the risk of serious blood clots.
• Seek immediate medical help for uncontrollable bleeding, excessive bruising, coughing up blood, vomiting blood, severe headaches or dizziness.

For years, Xarelto (rivaroxaban) has been a widely prescribed anticoagulant, helping lower the risk of blood clots that can lead to strokes, deep vein thrombosis (DVT), and pulmonary embolism (PE).

How Xarelto Works

Xarelto belongs to a class of medications called direct oral anticoagulants (DOACs). What makes DOACs different from older blood-thinning medications is how they work in your body. Traditional blood thinners affect multiple clotting factors, while DOACs are more targeted.

Blood clotting involves a series of steps, each dependent on specific proteins called clotting factors. Xarelto specifically blocks Factor Xa, a key factor that drives the clotting process. By inhibiting Factor Xa, Xarelto disrupts the formation of blood clots, reducing the risk of them traveling through the body and causing serious problems.

Who Might Be Prescribed Xarelto?

Xarelto (rivaroxaban) is prescribed to reduce the risk of blood clots in both adults and children.

Use in Adults

• Atrial Fibrillation (AFib) (Not caused by a heart valve problem)
  AFib is an irregular heartbeat that increases the risk of stroke. When the heart does not beat normally, blood flow slows down, increasing the chance of clot formation. These clots can travel to the brain and cause a stroke.
• Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)
  DVT is a blood clot in a deep vein, usually in the leg. A PE occurs when a DVT clot breaks loose and travels to the lungs, blocking blood flow. This is a life-threatening condition.
  Xarelto is used to treat DVT and PE and to help prevent future clots in patients who remain at risk after completing at least 6 months of blood clot treatment.
• Clot Prevention After Hip or Knee Replacement Surgery
  Surgery, especially joint replacements, increases the risk of blood clots due to limited movement during recovery.
• Hospitalized Patients at Risk of Blood Clots
  Hospitalized adults with limited mobility due to acute illness may be at risk for blood clots. Xarelto can reduce this risk during and after hospitalization, provided the patient does not have a high risk of bleeding.
• Coronary Artery Disease (CAD) and Peripheral Artery Disease (PAD)
  • CAD: In patients with narrowed arteries supplying the heart, Xarelto, taken with low-dose aspirin (75-100 mg), lowers the risk of serious heart problems like heart attacks and strokes.
  • PAD: In patients with reduced blood flow to the legs, Xarelto reduces the risk of sudden blood flow blockages, major amputations, strokes, or serious heart events. This includes patients who have recently had procedures to improve leg circulation.

Use in Children

Xarelto is also prescribed for children in certain situations where blood clot prevention is necessary:

• Treatment and Prevention of Blood Clots
  Xarelto can treat existing blood clots and reduce the risk of new clots in children from birth to under 18 years old. This is typically done after completing at least 5 days of injectable or intravenous anticoagulant therapy.
• Congenital Heart Disease
  Children aged 2 years and older with congenital heart disease may be prescribed Xarelto after the Fontan procedure. This surgery is performed to improve blood flow in children with specific heart conditions.

How to Take Xarelto

• Strengths: 2.5, 10, 15, 20 mg
• General Guidelines: Take exactly as prescribed. Never stop taking Xarelto without speaking to a healthcare provider, as stopping suddenly can increase the risk of developing serious blood clots.

Dosing and Missed Dose Instructions in Adults

• Atrial Fibrillation (AFib) (Not caused by a heart valve problem)
  Take Xarelto once daily with an evening meal.
  Missed Dose: Take it as soon as you remember on the same day. Take the next dose at the usual time the following day.
• Treatment of Blood Clots (DVT or PE)
  • Dosing (once or twice daily) will be determined by your doctor.
  • 10 mg doses can be taken with or without food.
  • 15 mg and 20 mg doses must be taken with food.
  • Missed Dose (15 mg twice daily): Take both missed doses together on the same day. Resume your regular dosing schedule the next day.
• Prevention of Blood Clots After Hip or Knee Replacement Surgery
  Take Xarelto once daily, with or without food.
  Missed Dose: Take it as soon as you remember on the same day. Take the next dose at the regular time.
• Clot Prevention in Hospitalized Patients
  • Take Xarelto once daily during hospitalization and after discharge, as prescribed by your doctor.
  • Can be taken with or without food.
  • Missed Dose: Take it as soon as you remember on the same day. Take the next dose at the regularly scheduled time.
• Coronary Artery Disease (CAD) or Peripheral Artery Disease (PAD)
  • Take 2.5 mg twice daily, with or without food.
  • Also, take low-dose aspirin (75-100 mg) once daily, as prescribed.
  • Missed Dose: Take the next scheduled dose at the usual time. Do not take extra doses to make up for the missed one.

Guidelines for Children

• Dosing Information
  • Dosage is based on your child's weight and determined by the doctor.
  • Xarelto may be given as tablets or an oral suspension.
  • Tablets should be swallowed whole; do not split them to adjust the dose.
  • For the oral suspension, use the provided syringe to measure the dose accurately. Give the suspension exactly as instructed.
• Missed Dose Instructions
  • 1 Dose Per Day: Take the missed dose as soon as possible on the same day. If it is close to the next scheduled time, skip the missed dose.
  • 2 Doses Per Day A missed morning dose can be taken with the evening dose. Do not make up a missed evening dose.
  • 3 Doses Per Day: Skip the missed dose. Take the next dose at the regular time.
• Vomiting Instructions
  • If vomiting occurs within 30 minutes of taking the oral suspension, give the full dose again.
  • If vomiting occurs more than 30 minutes later, do not repeat the dose. Give the next scheduled dose at the regular time.
  • Contact the doctor if vomiting persists.
• Clot Prevention in Hospitalized Patients
  • Take Xarelto once daily during hospitalization and after discharge, as prescribed by your doctor.
  • Can be taken with or without food.
  • Missed Dose: Take it as soon as you remember on the same day. Take the next dose at the regularly scheduled time.
• Additional Instructions
  • For children who have difficulty swallowing tablets, the tablet can be crushed and mixed with applesauce before taking it.
  • Never stop this medication without medical supervision, as this can increase the risk of serious blood clots.
  • Consult your doctor before switching between the tablet and oral suspension.
  • Contact your doctor with any concerns about dosing, side effects, or missed doses.

Side Effects

Common Side Effects

These side effects are more frequent but usually not dangerous:

• Mild bruising or nosebleeds
• Nausea or upset stomach
• Headaches or dizziness
• Fatigue or weakness

In children, additional side effects may include:

• Vomiting
• Cough
• Inflammation of the stomach or intestines

While these symptoms are often mild, it’s important to contact your doctor if they worsen or become persistent.

If you notice mild bruising or small nosebleeds, try to avoid activities that increase bleeding risk, such as contact sports.

Serious Side Effects

While many tolerate Xarelto without major problems, some may experience severe side effects requiring urgent medical attention.

• Increased Risk of Bleeding: Get immediate medical help if you experience any of the following:
  • Uncontrollable bleeding or excessive bruising
  • Frequent nosebleeds or bleeding gums
  • Heavy menstrual bleeding
  • Coughing up blood
  • Vomiting blood or material that looks like coffee grounds
  • Black or tar-like stools
  • Red or brown urine
  • Severe headaches, dizziness, or weakness
• Spinal or Epidural Blood Clots: Patients receiving spinal or epidural injections or spinal procedures while taking Xarelto may be at risk of a spinal blood clot. This can lead to long-term nerve damage or paralysis.
  Get immediate medical attention if you experience:
  • Severe back pain
  • Tingling or numbness in your legs
  • Muscle weakness
  • Loss of bladder or bowel control
• Increased Risk of Stroke if Stopped Abruptly: Patients taking Xarelto for AFib should never stop suddenly without a doctor's guidance. Stopping too soon increases the risk of stroke or other clot-related complications. If discontinuation is necessary, your doctor may switch you to another anticoagulant.

Drug Interactions: What to Avoid

Certain medications can increase your risk of bleeding when taken with Xarelto. Let your doctor know about all medications, including over-the-counter drugs, supplements, and herbal products.

Some medications that may increase your risk of bleeding include the following:

• Antiplatelet Drugs: Aspirin, clopidogrel, ticagrelor
• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Ibuprofen, naproxen
• Anticoagulants: Warfarin, heparin
• Selective Serotonin Reuptake Inhibitors (SSRIs): Fluoxetine, sertraline, paroxetine, citalopram, escitalopram
• Serotonin Norepinephrine Reuptake Inhibitors (SNRIs): Venlafaxine, duloxetine, desvenlafaxine

Speak with Your Doctor

Xarelto (rivaroxaban) is an effective medication in preventing blood clots, but it requires careful use and monitoring. Whether you’re starting treatment or have been on it for a while, it’s important to stay informed about how it works, potential risks, and what to expect.

Before taking Xarelto, talk to your doctor about any existing medical conditions, medications, or concerns about bleeding risks. If you experience any unusual symptoms, such as prolonged bleeding, severe headaches, or signs of a possible blood clot, get medical help right away.

If you ever need to stop taking Xarelto, do not discontinue it on your own. Your doctor may need to adjust your treatment plan to lower your risk of clot formation.

Every patient’s health needs vary, which is why talking to your doctor helps you receive the safest and most effective care while getting the most benefit from this medication and the most appropriate treatment plan.