Rivaroxaban (Xarelto): What it does and what you need to know

Rivaroxaban is a direct oral anticoagulant many doctors pick over older drugs because you usually don’t need regular blood tests. It’s used to prevent strokes in atrial fibrillation, treat and prevent deep vein thrombosis (DVT) and pulmonary embolism (PE), and to lower clot risk after hip or knee surgery.

How rivaroxaban works and common uses

Rivaroxaban blocks factor Xa, a key step in clot formation. That makes blood less likely to form dangerous clots. Typical uses and usual dosing patterns you’ll see:

- Non-valvular atrial fibrillation: 20 mg once daily with the evening meal. If your kidney function is reduced (creatinine clearance 15–50 mL/min), the common dose is 15 mg once daily. It’s generally not recommended if clearance is below 15 mL/min.

- Treating DVT/PE: 15 mg twice daily for the first 21 days, then 20 mg once daily with food.

- Preventing clots after hip or knee replacement: 10 mg once daily.

These are typical schedules but your doctor may adjust them for other health issues or interacting drugs.

Practical safety tips and what to watch for

Bleeding is the main risk. Watch for sudden heavy bruising, vomit with blood, pink or dark urine, bloody or black stools, or prolonged nosebleeds. If any of those happen, get medical help right away.

If you need surgery or a dental procedure, tell the clinician you’re on rivaroxaban. Many people stop it 24–48 hours before a procedure depending on bleeding risk and kidney function. Don’t stop on your own without advice.

There’s no routine blood test like INR to check how well it’s working. But your doctor will check kidney function before starting and at intervals after that. Also, carry an anticoagulant card or note that lists the drug and dose.

Missed dose rules: If you take it twice daily and miss a dose, take it as soon as you remember unless it’s almost time for the next dose; then skip the missed one. For once-daily doses, take it the same day if you remember, otherwise skip and resume the next day. Never double up to catch up without asking your doctor.

Drug interactions matter. Strong combined inhibitors of CYP3A4 and P-gp (like some antifungals and HIV protease inhibitors) can raise rivaroxaban levels and increase bleeding risk. Strong inducers (rifampin, carbamazepine, St. John’s wort) can lower its effect. Also be careful with NSAIDs, aspirin, and some antidepressants — they can raise bleeding risk when used together.

If major bleeding occurs, andexanet alfa is the approved reversal agent in many places; when it’s not available, clinicians may use four-factor prothrombin complex concentrate (PCC). Ask your provider what plan they’d use for you.

Final practical point: store the drug as directed, never change dose without talking to your prescriber, and if you buy medicines online, use only trusted pharmacies. If something feels off — unexplained bruises, dizziness, or unusual bleeding — call your doctor right away.