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Xarelto (rivaroxaban) is an anticoagulant used to treat or prevent blood clots. It is relatively new medication, introduced to the market in 2011. Xarelto provides a few advantages over its older competitors, like warfarin:

  • There are no known dietary restrictions while taking Xarelto.
  • Dosage adjustments are unlikely with Xarelto.
  • Regular blood monitoring is usually not needed.

Classic blood thinners like warfarin require diet modifications, often require frequent monitoring since dosage can be highly dependent on factors like age, weight, diet, and so forth, and because of those sensitivities dosage adjustments are not unusual. In this respect Xarelto is quite convenient.

That is not to say Xarelto doesn't have its drawbacks. While medications like warfarin can be counteracted, such as with vitamin K in warfarin, there is no such antidote for Xarelto. This can make managing bleeding challenging, with little choice but to wait for Xarelto to leave the system. Individuals prone to bleeding, such as frequent nosebleeds, or who regularly engage in work or activities where risk of injury is relatively high, may want to consider other options.

Preventing Blood Clots with Xarelto

Xarelto is predominantly used to prevent blood clots in three scenarios:

  • Atrial fibrillation (AFib).
  • Deep vein thrombosis (DVT) and pulmonary embolism (PE).
  • After hip or knee replacement surgery.

A doctor will be needed to determine the ideal dosage and duration of treatment; a number of variables need to be taken into consideration. Treatment will also vary to some extent depending on the condition being treated.

In AFib standard treatment is:

  • Treatment typically starts with 15 mg doses taken twice per day (30 mg total per day), taken with food.
  • After 21 days, dosage may be changed to 20 mg taken once per day, usually with the evening meal.
  • Treatment may continue indefinitely.

To treat or prevent deep vein thrombosis and/or pulmonary embolism:

  • Dosage will vary considerably between patients.
  • Doses may be taken once or twice per day, according to doctor instruction.
  • Doses of 10 mg or less may be taken with or without food as desired. Doses higher than 10 mg should be taken with food.
  • Treatment may continue indefinitely.

Following hip or knee replacement surgery:

  • The standard dose is 10 mg per day, taken once per day.
  • Tablets may be taken with or without food.
  • For knee replacement treatment typically continues for 12 days.
  • With hip replacement treatment typically continues for 35 days.

Again, the above guidelines may vary according to individual variables. Doctor instructions should be followed carefully to prevent complications.

Important Precautions

While Xarelto is a convenient medication, it is not without risk; it still carries many of the same risks as any other blood thinner. Most significant of those risks is excessive bleeding, since the body's clotting ability will be impaired. Patients taking this or any blood thinner should take care to:

  • Avoid risky activities where injury is likely, such as contact sports.
  • Be sure to notify doctors that Xarelto is being taken well in advance of surgery, including dental surgery. Treatment will likely need to stop for a while prior to surgery.
  • Notify a doctor right away if pregnancy is discovered while taking Xarelto. The effects of Xarelto on unborn or nursing babies are unclear, but there is significant risk of bleeding complications if blood thinners are taken during childbirth.
  • Avoid taking other medications that interfere with blood clotting or increase risk of bleeding, including over-the-counter products like aspirin.

There are a number of other medications, including over-the-counter medications and supplements like St. John's wort, which can interact with Xarelto. Double check with a doctor or pharmacist before taking any other medications while taking Xarelto.

Patients who have a history of spinal problems and/or spinal surgery, who have had multiple or difficult spinal punctures and/or epidurals, or who have these procedures performed while taking Xarelto, are at increased risk of potentially very serious complications. Take care to discuss risks and warning signs with a doctor before starting treatment with Xarelto.

Any unexplained or uncontrolled bleeding is a potential medical emergency while taking this or any blood thinner. Seek medical attention if:

  • Urine is pink, red, or brown
  • Stools are black or bright red
  • Vomit looks like coffee grounds or contains blood
  • Coughing up blood
  • Any bleeding cannot be controlled, even if it appears minor

The prospect of taking blood thinners may sound daunting, but in patients at high risk of blood clots blood thinners can be vital in helping maintain independence, high quality of life, and even preserve life itself. If the medication is used as directed and patients or caretakers stay alert for any potential complications, benefits nearly always outweigh risks.


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Medicines have benefits and some have risks. Always read the label and use only as directed. If symptoms persist or you have side effects see your health professional.

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