Rivaroxaban (brand name: Xarelto) is a newer anticoagulant medication. (This group of medications is sometimes called novel oral anticoagulants, or NOACs.) Anticoagulants are often referred to as blood-thinning medications, but what they actually do is make it take longer for the blood to clot. This is important for people who have atrial fibrillation (Afib or AF) and, therefore, are at increased risk for stroke. If you have Afib, your doctor may have prescribed an anticoagulant to reduce your risk for stroke.

The benefit of anticoagulant medications is that they keep blood from clotting. This is also a risk that comes with taking anticoagulants: they can prevent the blood from clotting when it needs to and can cause dangerous internal bleeding. For most people with Afib, the risk of a blood clot causing a stroke is greater than the risks that come with taking an anticoagulant. The decision to take an anticoagulants – and which one – needs to be carefully evaluated for each person, depending on your individual risk factors, medical history, ability to take medications exactly as prescribed and, in the case of warfarin (Coumadin), willingness to have regular blood tests that are used to monitor the effects of the drug. To learn about the tools doctors use to determine if anticoagulants are appropriate for individual patients, click here.

Several anticoagulants have been approved by the U.S. Food and Drug Administration. Click here to learn more about anticoagulant medications.

This page is meant to familiarize you with rivaroxaban and how it may be used to prevent blood clots that can cause stroke. Note: This information is intended only to provide an overview. It should not take the place of a doctor’s recommendation. Be sure to speak with your doctor about your condition, symptoms and treatment options.

Benefits & Risks of Rivaroxaban

If you are taking the anticoagulant warfarin (Coumadin), you will need to have regular blood tests (called International Normalization Ratio, or INR, checks) to monitor for abnormal bleeding. Rivaroxaban (and the other newer oral anticoagulants) does not require these tests. Nevertheless, rivaroxaban (and the other newer oral anticoagulants) can cause bleeding complications, some of which can be dangerous. As of fall 2015, rivaroxaban does not have an antidote available to counteract excessive bleeding and restore the body’s blood-clotting factors. (Warfarin and dabigatran do have antidotes.) You can learn more about antidotes here.

As with all medications, it is important that rivaroxaban is taken exactly as the directions specify.

If you are prescribed rivaroxaban, then you must take precautions to ensure that it does not interact with other medications (prescribed and over-the-counter), supplements and vitamins that you may be taking. This is why it is important to tell your care team about everything you take, including vitamins and supplements.

Rivaroxaban & Interactions

There are several medications, and types of medications, that people who are taking rivaroxaban need to avoid in order to prevent potentially dangerous complications. They include, but are not limited to, the following:

• Certain antifungal medications in the azole class, including itraconazole, ketoconazole and posaconazole
• Rifamycins, which is an antibiotic
• Cobicistat, which is used to treat infections in people with the human immunodeficiency virus (HIV)
• Conivaptan, which is often used to treat low sodium levels (hyponatremia)
• Some anticonvulsant drugs, including carbamazepine, phenytoin and phenobarbital
• HIV protease inhibitors (such as iopinavir and ritonavir)
• Aspirin
• NSAIDs, which is an abbreviation for “Non-Steroidal Anti-Inflammatory Drugs,” including ibuprofen (Motrin or Advil) and naproxen sodium (Aleve)

Rivaroxaban has also been known to interact with the herbal supplement St. John’s Wort. If you take any supplements, it is a good idea to make a list of them and bring them with you to your doctor’s appointments. Your care team will inventory what you are taking and let you know if there are any safety issues.

As a reminder, rivaroxaban has been found to interact with a number of prescription and over-the-counter medications. Be sure to tell your care team about everything you take. It’s also important to be aware of, and monitor yourself, for signs that your body may not be responding as it should to rivaroxaban.

Signs of Problems with Taking Rivaroxaban

If you are taking rivaroxaban, you should be alert for any changes in your body that could signify either a bleeding problem; a negative interaction with a medication, food or supplement; or other issues.

Symptoms that should be classified as an emergency, and about which you should contact your doctor immediately, include the following:

• Severe bleeding (In women, this may include a heavier-than-normal menstrual period.)
• Urine that is red or brown in color
• Frequent nosebleeds
• Stools that appear bloody or black in color
• Joint pain as well as swelling and discomfort in joints
• Bruising when you have not taken a fall or bumped something
• Vomiting of blood (or of anything that resembles coffee grounds)
• Severe weakness or dizziness
• Severe headache or stomachache

Other symptoms that indicate problems include bleeding of your gums when you brush your teeth, unexplained fever, diarrhea or vomiting that lasts more than 24 hours.

Learn More

If you have been recently diagnosed with atrial fibrillation, it is likely you have a number of questions to ask your doctor about your condition. To get you started, we invite you to download Questions to Ask Your Doctor About Atrial Fibrillation.

If you and your doctor are considering anticoagulant therapy, you may have specific questions about how it will affect you. Some common questions are provided in SecondsCount’s article on What You Need to Know About Anticoagulant Medications.