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Direct Oral Anticoagulant / AF / ACS

Rivaroxaban (AF / ACS)

Brand names: Xarelto

Used in: Venous Thromboembolism (DVT & PE)

Rivaroxaban is a direct oral anticoagulant (a factor Xa inhibitor) used for stroke prevention in non-valvular atrial fibrillation, for treatment and prevention of venous thromboembolism, and at low dose for vascular protection in coronary or peripheral arterial disease.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

Nonvalvular Atrial Fibrillation : 15 or 20 mg, once daily with food ( 2.1 ) Treatment of DVT and/or PE : 15 mg orally twice daily with food for the first 21 days followed by 20 mg orally once daily with food for the remaining treatment ( 2.1 ) Reduction in the Risk of Recurrence of DVT and/or PE in patients at continued risk for DVT and/or PE : 10 mg once daily with or without food, after at least 6 months of standard anticoagulant treatment ( 2.1 ) Prophylaxis of DVT Following Hip or Knee Replacement Surgery : 10 mg orally once daily with or without food ( 2.1 ) Prophylaxis of VTE in Acutely Ill Medical Patients at Risk for Thromboembolic Complications Not at High Risk of Bleeding : 10 mg …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2026-01-16. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Clinical monograph

How it works

Rivaroxaban directly and reversibly inhibits activated factor X (factor Xa), reducing thrombin generation and clot formation.

Prescribing in practice

  • The dose depends on the indication; treatment doses must be taken with food for reliable absorption.
  • Renal function affects dosing and suitability — avoid in severe renal impairment and review eGFR periodically.
  • It interacts with strong dual CYP3A4 and P-glycoprotein inhibitors or inducers; review co-medication.

Monitoring

No routine coagulation monitoring; check renal and hepatic function and full blood count at baseline and periodically.

Counselling the patient

  • Take treatment doses with food, at the same time each day.
  • Do not miss doses — protection wears off quickly.
  • Report unusual bleeding and tell clinicians or dentists you take an anticoagulant.

Evidence & guidelines

DOACs are recommended first-line over warfarin for non-valvular AF in NICE NG196; AF efficacy was shown in ROCKET-AF.

Reference: ROCKET-AF Trial (Patel et al. NEJM 2011); ATLAS ACS2-TIMI 51 (Mega et al. NEJM 2012); NICE TA256; SPC Xarelto; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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