If you have a blood clotting disorder, it’s important to manage it well to help reduce the risk of dangerous, life-threatening complications like heart attack and stroke.
Rivaroxaban (brand name Xarelto) is a medication that may help.
What is rivaroxaban (Xarelto)?
“Xarelto is a blood thinner (anticoagulant) used to prevent and treat blood clots, and to reduce the risk of stroke in people with atrial fibrillation (AFib),” said Paul Thompson, a pharmacist with Banner Pharmacy Services.
It’s in a class of medications known as direct oral anticoagulants (DOACs). It works by blocking an important protein in the blood clotting process called Factor Xa.
Rivaroxaban may be prescribed to:
- Help prevent stroke and clots that may block blood vessels in people with certain types of atrial fibrillation (AFib).
- Help treat and prevent deep vein thrombosis (DVT) and pulmonary embolism (PE).
Rivaroxaban is absorbed quickly from the digestive tract and reaches its peak concentration in the blood in a few hours. So, it can reliably prevent blood clots.
What are the benefits of rivaroxaban (Xarelto)?
Here's who can benefit from this medication:
- People with non-valvular AFib: Atrial fibrillation is a common heart rhythm disorder that makes it more likely that blood clots will form in the heart. If a clot develops and travels to the brain, it can cause a stroke.
- People with DVT or PE: These conditions happen when a blood clot forms in a leg or lung. They can cause life-threatening complications.
- People recovering from orthopedic surgery: People who have hip or knee replacement surgery are at higher risk of DVT and PE because of the surgery itself and the fact that they aren’t moving a lot afterward.
You may be able to take rivaroxaban once a day. “This can improve adherence compared to medications that require multiple daily doses,” Dr. Thompson said. Taking it with food helps your body absorb it, especially if you’re taking a higher dose.
Unlike other blood thinners, you don’t need to restrict your diet or regularly check your blood levels if you are on rivaroxaban.
Your health care provider can help you decide if rivaroxaban is a good choice for your medical needs and circumstances.
How to take rivaroxaban
“Take Xarelto exactly as prescribed by your doctor. Missing doses can increase the risk of blood clots,” Dr. Thompson said.
Most people take rivaroxaban once a day at dinnertime. The dose may vary depending on the reason you're taking the medication. Take rivaroxaban tablets whole with water. Don't crush, chew or break them.
It's important to take rivaroxaban at the same time each day so levels in your blood stay consistent. You may want to use a pill organizer or a smartphone reminder to help you remember.
If you miss a dose, take it as soon as you remember on the same day. If you remember the next day, skip the missed dose and go back to your regular schedule. Do not take a double dose to make up for one that you missed unless your provider says that you should.
Let your provider know if you often forget to take your medication or have trouble following the dosing schedule.
Store rivaroxaban tablets at room temperature away from moisture and heat and in its original packaging.
Possible side effects of rivaroxaban (Xarelto)
Most people tolerate rivaroxaban well, but it can cause side effects.
Common side effects:
- Bleeding: Rivaroxaban can increase your risk of bleeding. This could be minor bleeding like nose bleeds or bruises, or more serious bleeding in your digestive system or brain. “Inform your doctor about any unusual bleeding or bruising,” Dr. Thompson said.
- Nausea: You may have nausea when you’re taking rivaroxaban. Nausea is usually mild and may clear up if you take the medication with food.
Serious side effects:
- Allergic reactions: In rare cases, rivaroxaban can cause allergic reactions. Symptoms include rash, itching, dizziness, trouble breathing or swelling in the face, tongue or throat. Get immediate medical attention for signs of an allergic reaction.
- Spinal/epidural hematoma: This serious side effect, which may cause long-term or permanent paralysis, can happen if you use rivaroxaban with certain types of anesthesia or spinal puncture procedures. Tell your health care provider right away if you have symptoms such as numbness or weakness in the legs, loss of control of the bowels or bladder or severe back pain.
If you have any side effects while taking rivaroxaban, especially if they are severe or concerning, contact your health care provider immediately. Your doctor may adjust your dosage or recommend other treatments.
For a severe allergic reaction, bleeding that does not stop or symptoms of spinal/epidural hematoma (a pool of blood under the skin that looks like a firm bruise), seek emergency medical help right away.
Precautions and warnings
Some people should not take rivaroxaban or need to be monitored closely if they take it.
You should avoid rivaroxaban if you have active major bleeding, a history of bleeding disorders or if you’re allergic to rivaroxaban or any of its ingredients.
If you take other blood thinners, including aspirin, heparin and non-steroidal anti-inflammatory drugs (NSAIDs such as Motrin, Advil or Aleve), you may have a higher risk of bleeding. You'll need to use rivaroxaban with caution under your provider’s care. “Avoid taking other medications or supplements that can increase bleeding risk, such as NSAIDs or certain herbal supplements, without consulting your doctor,” Dr. Thompson said.
Some antifungal and antibiotic medications, such as ketoconazole rifampin, may interact with rivaroxaban and change its effectiveness. Tell your provider about all medications you are taking, including over-the-counter (OTC) drugs and supplements.
“Regular follow-ups with your health care provider are essential to ensure the medication is working effectively and safely,” Dr. Thompson said.
In follow-up visits, your provider will check for any signs of bleeding or other complications and adjust your treatment if needed. They may suggest monitoring your blood and kidney function.
Tips for managing blood clotting disorders
Along with medication, these tips can help you manage your condition:
- Eat a well-balanced diet rich in fruits, vegetables, lean proteins and whole grains.
- Avoid large amounts of foods high in vitamin K, such as leafy green vegetables, since they can interfere with rivaroxaban. Keep your intake of vitamin K-rich foods consistent. If your diet changes significantly, tell your provider. They may need to adjust your medication.
- Get regular physical activity. Exercise promotes circulation, reduces the risk of blood clots and supports overall heart health. Avoid high-risk sports or activities that may increase the risk of injury. If you have questions about safe options, talk to your provider.
- Watch for signs of bleeding, including excessive bruising, bleeding from minor cuts, nosebleeds or blood in urine or stool. Get immediate medical attention for severe bleeding that does not stop with pressure, blood in coughed-up mucus or symptoms like severe abdominal pain, dizziness or fainting that could be signs of internal bleeding.
- Report any signs of bleeding or unusual symptoms to your health care provider. They can evaluate your condition and adjust your treatment plan as needed.
- Inform your health care provider or dentist that you are taking Xarelto before any surgery or dental work to manage the risk of excessive bleeding.
- Carry a medical alert card or wear a bracelet indicating you are on Xarelto, since this information is critical for emergency medical personnel.
The bottom line
Rivaroxaban (Xarelto) may help prevent strokes in people with atrial fibrillation and treat and prevent deep vein thrombosis and pulmonary embolism. It can be a convenient option compared to other blood thinners. But it can cause bleeding and other serious side effects and it’s not the right choice for everyone.
Your health care provider or an expert at Banner Health can review your health history and help you decide if rivaroxaban is a good option for you.
Other useful articles
- 5 Things to Know About Taking Blood Thinners
- How Atrial Fibrillation (AFib) Could Affect Your Heart’s Health
- Apixaban (Eliquis): What You Need to Know
The content in this article is for informational use only. Always discuss any medication with your health care provider or pharmacist before taking it. Also, refer to the medication package insert supplied by the pharmaceutical manufacturer with your prescription.
