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Xarelto Explained: 10 Must-Knows About This Life-Saving Drug

Medically reviewed on Jan 30, 2017 by L. Anderson, PharmD.

1. Xarelto: It's Not Just a Tongue-Twister

Xarelto (pronounced zah-REL-toe) is a drug that may be easier to understand than pronounce. But for many, it's a life-saving drug. Here's what it does: Xarelto (rivaroxaban), an anticoagulant (blood thinner), is a tablet given by mouth once or twice a day. It prevents or treats blood clots called a deep vein thrombosis (DVT), which can lead to a lung clot (pulmonary embolism or PE). A clot can also occur after certain surgeries, like knee or hip replacements. Xarelto is also an option for people who have an abnormal heart rhythm not caused by a heart valve problem (non-valvular atrial fibrillation) to help prevent clots that may travel to the brain and cause a stroke.

2. How Does Xarelto Work?

Xarelto belongs to a class of drugs known as Factor Xa inhibitors. Factor Xa inhibitors are anticoagulants that block the activity of clotting factor Xa and prevent blood clots from developing or getting worse. Factor Xa activates the blood protein prothrombin to thrombin, which triggers the final components of the coagulation pathway to form clots.

Other Factor Xa inhibitors that work like Xarelto include fondaparinux (Arixtra), apixaban (Eliquis), and edoxaban (Savaysa). However, newer anticoagulants are costly compared to warfarin; it may not be the right drug for everyone.

3. Goodbye to Routine Blood Work.

Maybe you've used the blood thinner warfarin - now or in the past. For many years, warfarin was the blood thinner of choice. However, for some patients, warfarin can be cumbersome to use. It requires regular trips to the lab for blood work to check the dose.

Food interactions are a concern with warfarin; such as altering amount of food eaten with high levels of vitamin K. However, Xarelto does not require regular blood tests or have food restrictions. Studies have shown that blood levels remain constant with Xarelto for a more predictable effect to prevent clots.

A 2017 study showed that over one-third of patients with atrial fibrillation who took warfarin and who also had a cardioversion stopped taking their warfarin within one year, possibly due to bruising or the required lab tests. If you are on warfarin, do not stop it without your doctors advice; this could increase your risk for a stroke.

4. Cautious Use: Signs of Bleeding

The most common (> 5%) side effect with Xarelto is bleeding. You may bruise easily or take longer to stop bleeding from a minor cut. Get medical help immediately if you have:

  • Frequent nose bleeds or bleeding gums
  • Heavy menstrual or vaginal bleeding
  • Uncontrollable bleeding
  • Red, pink or brown urine
  • Bright red or black, tarry stools
  • Cough up blood or vomit looks like “coffee grounds”
  • Headaches, dizzy or weak
  • Pain, swelling

5. Drugs Interactions: Risky With Xarelto

It's important to know that if you take Xarelto with another blood-thinning medication, both drugs added together may increase your bleeding risk. Examples include:

Tell your doctor and pharmacist if you take any of these medicines and have a drug interaction screen completed.

6. Xarelto: Other Drug Interactions

Xarelto drug interactions can occur with many other medicines. It's important to tell your doctor if you take:

Select the drug names above to see details of the drug interaction with Xarelto. Be sure your doctor or pharmacist checks for drug interactions with each of your prescriptions.

7. Antidotes Under Research

Vitamin K is a quick reversal agent to help treat bleeding with the older anticoagulant warfarin. However, Xarelto, a member of the class of drugs known as Factor Xa inhibitors, does not have a reversal agent - yet. A reversal agent known as andexanet alfa, being developed by Portola Pharmaceuticals, is in late-stage research.

Andexanet alfa is being developed as an antidote for patients receiving an oral or injectable Factor Xa inhibitor who suffer a major bleeding episode or who may require emergency surgery. It is designated as a breakthrough therapy and Orphan Drug by the FDA. In August 2016, Portola Pharmaceuticals Inc. announced the receipt of a Complete Response Letter (CRL) from the FDA regarding its Biologics License Application (BLA) for andexanet alfa. In the CRL, the FDA requested that Portola provide additional information related to manufacturing and additional data to support inclusion of edoxaban and enoxaparin in the label.

8. Food and Xarelto: Know Your Dose

How you take Xarelto in relation to eating may be important for you. The higher doses of Xarelto - the 15 and 20 milligram (mg) tablets - should be taken with food to increase the absorption of the medicine. If you are taking Xarelto for stroke prevention in atrial fibrillation, take your dose with the evening meal.

If you are taking the 15 or 20 mg tablets for treatment of deep vein thrombosis (DVT) or pulmonary embolism (PE), or to reduce the risk for occurrence of a DVT or PE, take your tablets with food as directed by your doctor. The lower 10 mg dose, used to prevent a DVT after knee or hip replacement surgery, can be taken with or without food.

9. Warnings and Tips for Xarelto

Certain groups need to pay attention to special warnings with Xarelto. Talk with your doctor about taking Xarelto if:

Talk to your doctor about any concerns you may have and do not stop taking Xarelto on your own. Be sure to keep up with your refills so you do not miss any doses. Refill your Xarelto prescription before it runs outs.

10. Get to Know Your Pharmacist

If you are using Xarelto, it's important to communicate regularly with your doctor and pharmacist about treatment, even though you are not having regular lab tests.

A recent study showed that patients whose prescriptions were filled by a Veteran's Affairs (VA) pharmacist - who also educated them about the drug and reviewed their therapy - were 80% more likely to take the drug correctly and without missing doses than those who didn't receive such assistance. Stopping Xarelto, missing a dose, or taking it incorrectly can greatly boost your risk of a stroke or lung embolism, which can be deadly. Talk to your doctor before you change your Xarelto treatment in any way.

Finished: Xarelto Explained: 10 Must-Knows About This Life-Saving Drug

Atrial Fibrillation - Stroke Prevention Guidelines & Treatment Options

Does warfarin still have a place in the prevention of stroke in non-valvular atrial fibrillation?



  • Xarelto Prescribing Information. Janssen Pharmaceuticals. Revised May 2016. Accessed 1/30/2017 at
  • Pharmacists Key to Whether Patients Take Blood Thinners. April 14, 2015. Accessed 1/30/2017 at
  • Wolters Kluwer. UpToDate. Rivaroxaban Patient Drug Information (Lexicomp). Accessed 1/30/2017 at