What are the common side effects of Xarelto. How can you manage the potential risks associated with this blood thinner. What should patients know about serious complications and their prevention.

Understanding Xarelto: A Powerful Blood Thinner

Xarelto, known by its generic name rivaroxaban, is a potent anticoagulant medication prescribed to prevent and treat various blood clot-related conditions. As a factor Xa inhibitor, it plays a crucial role in managing potentially life-threatening situations. However, like all medications, it comes with its own set of side effects that patients and healthcare providers must be aware of.

Key Uses of Xarelto

• Preventing stroke in patients with atrial fibrillation
• Treating deep vein thrombosis (DVT) and pulmonary embolism (PE)
• Reducing the risk of DVT and PE recurrence
• Preventing blood clots after knee or hip replacement surgery
• Managing coronary artery disease and peripheral artery disease
• Preventing blood clots in hospitalized patients with acute illnesses

Xarelto’s versatility extends to pediatric patients as well, offering treatment options for venous thromboembolism (VTE) and prevention of blood clots in children with congenital heart disease who have undergone the Fontan procedure.

Common Side Effects of Xarelto: What to Expect

While Xarelto is generally well-tolerated, patients may experience several common side effects. These effects are typically mild and often resolve on their own as the body adjusts to the medication.

Most Frequently Reported Side Effects

• Abdominal pain
• Back pain
• Dizziness
• Itching
• Bleeding (various types)

Can these side effects be managed at home? In many cases, yes. For instance, abdominal discomfort may be alleviated by taking Xarelto with food. Dizziness often improves as your body adapts to the medication, but it’s crucial to avoid activities requiring full alertness until you know how Xarelto affects you.

Additional Mild Side Effects

Patients may also experience:

• Muscle spasms
• Sleep disturbances
• Anxiety
• Depression
• Fatigue

Are these side effects cause for concern? While generally not serious, persistent or bothersome symptoms should be reported to your healthcare provider. They can offer strategies to manage these effects or adjust your treatment plan if necessary.

Serious Side Effects: Recognizing and Responding to Risks

While less common, Xarelto can cause serious side effects that require immediate medical attention. Understanding these risks is crucial for patient safety.

Major Bleeding Events

The most significant risk associated with Xarelto is severe or fatal bleeding. This can occur in various parts of the body and may not be immediately apparent.

What are the signs of a major bleeding event? Look out for:

• Unexplained bruising or bleeding that doesn’t stop
• Coughing up blood or coffee ground-like material
• Red or black, tarry stools
• Severe headache or dizziness
• Unusual weakness or fatigue

If you experience any of these symptoms, seek immediate medical attention. Prompt intervention can be life-saving in cases of severe bleeding.

Blood Clots After Discontinuation

Abruptly stopping Xarelto can lead to an increased risk of blood clots. This is why the medication carries a boxed warning from the FDA regarding premature discontinuation.

How can patients safely stop taking Xarelto? Always consult your healthcare provider before discontinuing Xarelto. They may recommend transitioning to another anticoagulant or implementing a tapering schedule to minimize risks.

Spinal/Epidural Hematoma

Patients undergoing spinal procedures while on Xarelto are at risk of developing a spinal or epidural hematoma, which can lead to long-term or permanent paralysis.

What precautions should be taken for spinal procedures? Inform all healthcare providers about your Xarelto use, especially before any medical procedures. Special care and timing considerations are crucial for patients requiring spinal interventions.

Managing Xarelto Side Effects: Strategies for Patients

Effectively managing side effects can significantly improve the patient experience and ensure the continued benefits of Xarelto therapy.

Open Communication with Healthcare Providers

Maintaining an open dialogue with your doctor is crucial. Report any new or worsening symptoms promptly. Your healthcare team can provide tailored advice and may adjust your treatment plan if necessary.

Lifestyle Modifications

Simple changes can help mitigate some side effects:

• Take Xarelto with food to reduce gastrointestinal discomfort
• Stay well-hydrated to help combat dizziness
• Practice good sleep hygiene to address sleep disturbances
• Engage in gentle exercise, as approved by your doctor, to improve overall well-being

Bleeding Prevention Strategies

Patients on Xarelto should take extra precautions to prevent injuries:

• Use an electric razor instead of a manual one
• Be cautious with sharp objects and tools
• Wear protective gear during physical activities
• Avoid contact sports or high-risk activities

How can patients balance safety with maintaining an active lifestyle? Discuss your hobbies and daily activities with your healthcare provider. They can offer personalized advice on safe ways to stay active while minimizing bleeding risks.

Special Considerations for Pediatric Patients

Xarelto’s use in children comes with unique considerations and side effect profiles that differ somewhat from adult patients.

Pediatric-Specific Side Effects

In addition to the side effects observed in adults, children taking Xarelto may experience:

• Coughing
• Vomiting
• Inflammation of the stomach and intestines

How should parents monitor their children on Xarelto? Keep a close eye on your child’s behavior and any physical changes. Regular check-ins with the pediatrician are crucial for monitoring the child’s response to the medication and addressing any concerns promptly.

Dosing and Administration Challenges

Accurate dosing is critical in pediatric patients. Xarelto is available as an oral suspension for children, which requires careful measurement and administration.

What steps can ensure accurate dosing for children? Use the provided dosing syringe, shake the bottle well before each use, and follow the prescribed dosing schedule meticulously. If you have any doubts about administration, consult your healthcare provider or pharmacist for guidance.

Interactions and Contraindications: Enhancing Xarelto Safety

Understanding potential interactions and situations where Xarelto should be avoided is crucial for patient safety.

Drug Interactions

Xarelto can interact with various medications, potentially increasing bleeding risks or reducing its effectiveness.

Which medications should be avoided with Xarelto? Common interactions include:

• Other anticoagulants or blood thinners
• Certain antidepressants (SSRIs, SNRIs)
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Some antifungal medications
• Certain HIV medications

Always inform your healthcare provider about all medications, supplements, and herbal products you’re taking to avoid potential interactions.

Contraindications

Xarelto is not suitable for everyone. It’s contraindicated in patients with:

• Active major bleeding
• Severe kidney or liver disease
• Pregnancy (especially in the later stages)
• Certain types of artificial heart valves

How can patients ensure they’re suitable candidates for Xarelto? Provide a comprehensive medical history to your healthcare provider, including any past bleeding events, surgeries, or chronic conditions. Regular check-ups and laboratory tests can help monitor your suitability for continued Xarelto therapy.

Long-Term Use of Xarelto: What Patients Should Know

For many conditions, Xarelto is prescribed as a long-term medication. Understanding the implications of extended use is essential for patient safety and treatment success.

Monitoring and Follow-Up

Regular medical check-ups are crucial for patients on long-term Xarelto therapy. These visits allow healthcare providers to assess the medication’s effectiveness and monitor for any developing side effects.

What should long-term follow-up include? Expect periodic blood tests to check kidney function and monitor for signs of anemia. Your doctor may also reassess your bleeding risk and adjust your treatment plan if necessary.

Lifestyle Considerations

Long-term use of Xarelto may require some lifestyle adjustments to ensure safety and maximize benefits:

• Maintain a consistent diet, especially regarding vitamin K intake
• Stay physically active, but avoid high-impact or contact sports
• Wear a medical alert bracelet indicating Xarelto use
• Plan ahead for travel, ensuring you have enough medication and relevant medical information

How can patients balance the benefits of Xarelto with potential lifestyle changes? Work closely with your healthcare team to develop strategies that allow you to maintain your quality of life while adhering to necessary precautions. Many patients find that with proper planning and communication, they can continue most of their regular activities safely.

Long-Term Side Effect Vigilance

While many side effects of Xarelto occur early in treatment, some may develop or become more pronounced over time. Patients should remain vigilant for:

• Subtle signs of chronic bleeding, such as persistent fatigue or shortness of breath
• Changes in kidney or liver function
• Unexpected bruising or bleeding events, even if minor

What should patients do if they suspect a long-term side effect? Don’t hesitate to contact your healthcare provider, even if the symptom seems minor. Early detection and management of side effects can prevent more serious complications and ensure the continued effectiveness of your treatment.

Navigating Emergency Situations on Xarelto

Patients taking Xarelto must be prepared for potential emergency situations, especially those involving bleeding or the need for urgent medical procedures.

Emergency Bleeding Management

In the event of severe bleeding, quick action is crucial. Andexanet alfa, a reversal agent for factor Xa inhibitors like Xarelto, may be used in emergency situations to counteract the blood-thinning effects.

What steps should patients take in a bleeding emergency? Seek immediate medical attention. Inform emergency responders that you’re taking Xarelto. If possible, bring your medication or a list of your current medications to the hospital.

Urgent Medical Procedures

Sometimes, patients on Xarelto may need urgent surgery or other invasive procedures. This requires careful management to balance the risks of bleeding with the need for the procedure.

How is Xarelto managed for urgent procedures? Your healthcare team will assess the urgency of the procedure against the bleeding risk. They may recommend temporarily stopping Xarelto, using reversal agents, or proceeding with extra precautions, depending on the situation.

Patient Preparedness

Being prepared for emergencies can make a significant difference in outcomes:

• Carry a card or wear a medical alert bracelet indicating Xarelto use
• Keep a list of all your medications and dosages
• Inform family members or close friends about your medication and potential risks
• Know the signs of serious bleeding and when to seek emergency care

How can patients ensure they’re adequately prepared for emergencies? Discuss an emergency plan with your healthcare provider. This may include knowing which local hospitals are equipped to handle Xarelto-related emergencies and having contact information for your healthcare team readily available.

By understanding the side effects, risks, and management strategies associated with Xarelto, patients can work closely with their healthcare providers to maximize the benefits of this powerful medication while minimizing potential complications. Regular communication, vigilant monitoring, and a proactive approach to managing side effects are key to a successful and safe treatment experience with Xarelto.

What they are and how to manage them

Xarelto (rivaroxaban) is a prescription brand-name medication. It’s approved by the Food and Drug Administration (FDA) to prevent and treat certain blood clots. Depending on the condition it’s used for, Xarelto may be prescribed for either short-term or long-term use.

Xarelto is specifically approved for use in adults to:

• reduce the risk of blood clots and stroke related to atrial fibrillation that isn’t caused by a heart valve problem
• treat deep vein thrombosis (DVT) or pulmonary embolism (PE), which are types of blood clots
• reduce the risk of developing another DVT or PE in certain people who have already had at least 6 months of initial treatment for DVT or PE
• prevent DVT and PE from developing after knee replacement or hip replacement surgery
• reduce the risk of major heart and blood vessel problems (including heart attack, stroke, or death) in people who have coronary artery disease
• reduce the risk of complications related to blood clots in people with peripheral artery disease
• prevent blood clots in certain people who are hospitalized with an acute (sudden or short-term) medical illness and are at risk for developing blood clots

Xarelto is also approved for use in children to:

• treat venous thromboembolism (VTE) and lower the risk of additional VTEs in children of all ages who have already had at least 5 days of initial blood thinner treatment
• prevent blood clots in children ages 2 years and older who have congenital heart disease and have had the Fontan procedure (a type of open-heart surgery)

Here are some fast facts on Xarelto:

• Active ingredient: rivaroxaban
• Drug class: anticoagulant (blood thinner) that inhibits factor Xa
• Drug forms: oral tablet, oral liquid suspension

Like other drugs, Xarelto can cause side effects. Read on to learn about potential common, mild, and serious side effects. For a general overview of Xarelto, including details about its uses, see this article.

Xarelto can cause certain side effects, some of which are more common than others. These side effects may be temporary, lasting for a few days or weeks. But if the side effects last for longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.

These are just a few of the more common side effects reported by people who took Xarelto in clinical trials:

• abdominal (belly) pain
• back pain
• dizziness
• itching
• bleeding (see “Side effect specifics” below)

Mild side effects can occur with Xarelto use. This list doesn’t include all possible mild side effects reported with the drug. For more information, you can refer to Xarelto’s prescribing information.

Mild side effects of Xarelto can include:

• abdominal (belly) pain
• back pain
• itching
• dizziness
• muscle spasms (involuntary muscle tightening)
• trouble sleeping
• anxiety
• depression
• fatigue*
• bleeding*

These side effects may be temporary, lasting for a few days or weeks. But if the side effects last for longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks side effects of the medication. If you develop a side effect while taking Xarelto and want to tell the FDA about it, visit MedWatch.

* For more information on this side effect, see “Side effect specifics” below.

Xarelto may cause serious side effects, although these weren’t common in clinical trials. The list below may not include all possible reported serious side effects of the drug. For more information, you can refer to Xarelto’s prescribing information.

If you develop bad or serious side effects while taking Xarelto, call your doctor right away. If the side effects seem life threatening or you think you’re having a medical emergency, immediately call 911 or your local emergency number.

Serious side effects, which are explained in more detail in the “Side effect specifics” section below, include:

• serious or fatal bleeding
• blood clots after stopping Xarelto too soon*
• a spinal or epidural hematoma*
• allergic reaction†

* Xarelto has a boxed warning for this side effect. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). To learn more, see the “Side effect specifics” section below.
† An allergic reaction is possible after using Xarelto. Although this side effect wasn’t reported in clinical trials, allergic reaction has been reported in people taking Xarelto since the drug was approved.

Some side effects were more common in children in Xarelto’s clinical trials. These side effects include bleeding, which was also a common side effect in adults. And the following side effects were not reported in adults, but were reported in children:

• coughing
• vomiting
• inflammation of the stomach and intestines

However, it’s possible for any of Xarelto’s side effects in adults to also occur in children.

In clinical trials of Xarelto, researchers specifically looked at whether side effects in older adults were different from those in younger adults.

In these trials, people 65 years and older were more likely to experience bleeding as a side effect of Xarelto. No other age-related differences in side effects were seen.

If you have questions about Xarelto’s side effects given your age, talk with your doctor or pharmacist. And for more information about bleeding as a side effect of Xarelto, see the “Side effect specifics” section below.

Xarelto may cause several side effects. Here are some frequently asked questions about the drug’s side effects and their answers.

Can Xarelto affect the liver?

It’s not likely. Liver-related side effects weren’t seen in people taking Xarelto in clinical trials.

Since the drug was approved, there have been reports of liver-related side effects in people taking Xarelto. These side effects include liver damage and hepatitis (inflammation in your liver). But it’s unclear how often these side effects may occur and if Xarelto may be the cause.

If you have questions about how Xarelto may affect your liver, talk with your doctor.

What are the side effects of the 20-milligram strength of Xarelto?

In a clinical trial, people who took the 20-milligram (mg) strength of Xarelto reported side effects such as:

• abdominal (belly) pain
• fatigue
• back pain
• muscle spasms (involuntary muscle tightening)
• dizziness
• anxiety
• depression
• trouble sleeping
• itching

In this trial, people took Xarelto to treat either deep vein thrombosis or pulmonary embolism, which are types of blood clots.

If you’re experiencing side effects from taking Xarelto, including the 20-mg strength, talk with your doctor about treatment options.

Is hair loss a side effect of Xarelto?

No, hair loss wasn’t reported as a side effect in people taking Xarelto in clinical trials.

If you have questions about potential hair loss while taking Xarelto, talk with your doctor.

Can Xarelto cause weight gain?

It’s unlikely. In clinical trials, people taking Xarelto didn’t report weight gain as a side effect.

If you have questions or concerns about weight gain while you’re taking Xarelto, talk with your doctor. They can recommend ways to help you maintain a body weight that’s healthy for you.

Are there any side effects of stopping Xarelto treatment?

Yes, it’s possible to experience side effects from stopping Xarelto. In fact, Xarelto has a boxed warning for the risk of blood clots if you stop taking the drug before the recommended duration of treatment. See the “Side effect specifics” section just below for more information about this.

If you have questions about side effects after you stop taking Xarelto, talk with your doctor or pharmacist.

Learn more about some of the side effects that Xarelto may cause.

Fatigue

Fatigue (lack of energy) is a possible side effect of Xarelto.

This side effect was somewhat common in people taking Xarelto in clinical trials. But no one reported severe fatigue or stopped taking Xarelto due to fatigue.

What you can do

If you have fatigue while taking Xarelto, talk with your doctor. They may suggest ways to treat this side effect. If fatigue is affecting your daily life, your doctor may suggest a drug other than Xarelto for you.

Bleeding

Bleeding was the most common side effect reported in people taking Xarelto in clinical trials.

Xarelto is an anticoagulant (blood thinner), which is a drug that makes it harder for your body to form blood clots. So it’s not unusual that the drug increases your risk for bleeding. But it’s important to be aware that Xarelto can cause bleeding anywhere in your body, including internal bleeding. Internal bleeding can affect your organs, such as your stomach, lungs, brain, and eyes.

Xarelto may cause both mild and severe bleeding. In very rare cases, severe bleeding from Xarelto can be fatal. Most people who reported bleeding in clinical trials experienced mild bleeding. This may cause you to bleed or bruise more easily than usual. It may also cause bleeding to take longer than usual to stop.

The following symptoms may indicate more severe bleeding:

• bleeding that lasts for a long time or is heavier than usual
• unexpected bleeding, such as unusual bleeding from the gums
• severe bleeding, or bleeding that you can’t control
• vomiting blood (which may look similar to coffee grounds, in some cases)
• stool that’s red or black and tarry
• brown, red, or pink urine
• coughing up blood or blood clots
• unusual vaginal bleeding or heavy periods
• headache, dizziness, or weakness (which could be symptoms of bleeding in your head or brain)
• new or worsening symptoms at wound sites after you’ve had surgery, such as pain, swelling, or fluid drainage

If you develop severe bleeding, your doctor may treat it with an injection of a drug called Andexxa. This drug works to reverse the effects of Xarelto (specifically, to stop Xarelto from preventing blood clot formation in your body). It’s used to treat severe, uncontrolled, or life threatening bleeding in people taking drugs such as Xarelto.

Note: Xarelto has a boxed warning for bleeding around the brain or spine. A boxed warning is a serious warning from the FDA. See “Risk of spinal or epidural hematoma” below for details.

What you can do

Talk with your doctor about your risk for bleeding while taking Xarelto. It’s also important to monitor yourself for any unusual bleeding or bruising while taking Xarelto. Make sure that you (and any caregivers) know what symptoms to watch for.

If you experience any of the symptoms of severe bleeding listed above, call 911 (or your local emergency number) immediately. Or, go to your nearest emergency room.

Abdominal pain

Xarelto may cause abdominal (belly) pain. This was a somewhat common side effect in people taking Xarelto in clinical trials. But no one reported severe abdominal pain or stopped taking Xarelto due to abdominal pain in these trials.

What you can do

Abdominal pain can be a side effect of Xarelto. But it can also be a symptom of internal bleeding, such as bleeding in your stomach or intestines.*

For this reason, if you have abdominal pain while taking Xarelto, call your doctor. They’ll likely want to examine you to help determine if your pain is a symptom of a more serious side effect. If your abdominal pain is mild and likely not a symptom of bleeding, your doctor may suggest treatments to relieve this side effect.

* For more information on bleeding with Xarelto, see “Bleeding” just above.

Risk of blood clots if you stop taking Xarelto too soon

Xarelto has a boxed warning for the risk of blood clots if you stop taking the drug too soon. A boxed warning is a serious warning from the Food and Drug Administration (FDA). It alerts doctors and patients about drug effects that may be dangerous.

If you stop taking Xarelto before the recommended length of treatment, your risk for having a blood clot increases. If you have a condition that affects your arteries or heart, stopping Xarelto also increases your risk for heart attack and stroke. Examples of these conditions include peripheral artery disease and coronary artery disease.

Symptoms of a blood clot vary depending on the location of the clot and may include:

• pain and swelling, which can affect a specific area of the body, such as the calf
• trouble breathing
• nausea
• lightheadedness

For more information about this warning, see Xarelto’s drug label information. You can also talk with your doctor.

What you can do

You should not stop taking Xarelto unless your doctor instructs you to do so.

Sometimes, you may need to temporarily stop taking Xarelto, with your doctor’s approval. This may be recommended before certain dental, medical, or surgical procedures. Your doctor will give you specific dates for when to stop taking Xarelto and when to start taking it again after your procedure. And, in the time leading up to your procedure, your doctor may prescribe a medication other than Xarelto for your condition.

Risk of spinal or epidural hematoma

Xarelto has a boxed warning for risk of spinal or epidural hematoma. A boxed warning is a serious warning from the FDA. It alerts doctors and patients about drug effects that may be dangerous.

If you receive certain injections while taking Xarelto, there’s a risk of bleeding around your spine or brain. These injections include spinal and epidural injections, such as lumbar punctures.

It’s possible that this bleeding around your spine or brain could cause a spinal or epidural hematoma. A spinal hematoma is a buildup of blood around your spine. And an epidural hematoma is a buildup of blood around your brain. These hematomas can cause brain damage or paralysis (an inability to move parts of the body), either of which can be long lasting or permanent.

You may be at higher risk for a spinal or epidural hematoma if you:

• take other medications that affect your body’s ability to form blood clots, including:
  • other blood thinners,* such as aspirin or clopidogrel (Plavix)
  • nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin, Advil) or naproxen (Aleve)
• have a history of repeated or difficult spinal or epidural injections
• have a history of spinal surgery or problems with your spine

For more information about this warning, see Xarelto’s drug label information. You can also talk with your doctor.

* Xarelto is also a blood thinner. Blood thinners are also called anticoagulants.

What you can do

If your doctor determines that it’s necessary for you to receive a spinal or epidural injection while you’re taking Xarelto, they’ll monitor you for symptoms of bleeding around your brain or spine. These symptoms may include:

• loss of control over your bladder or bowels
• back pain
• numbness
• tingling
• muscle weakness

Numbness, tingling, and muscle weakness are particularly likely to affect your feet and legs.

If you have any of the above symptoms while taking Xarelto, talk with your doctor immediately.

Allergic reaction

As with most drugs, Xarelto can cause an allergic reaction in some people. This side effect wasn’t reported in clinical trials, but it has been reported since the drug was approved.

Symptoms can be mild or serious and can include:

• rash
• itching
• flushing
• swelling under your skin, typically in your lips, eyelids, feet, or hands
• swelling of your mouth, tongue, or throat, which can make it hard to breathe

What you can do

For mild symptoms of an allergic reaction, call your doctor right away. They may recommend ways to ease your symptoms and determine whether you should keep taking Xarelto. But if your symptoms are serious and you think you’re having a medical emergency, immediately call 911 or your local emergency number.

Below are precautions to be aware of before you begin taking Xarelto.

Boxed warnings

This drug has boxed warnings. These are serious warnings from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous.

• Risk of blood clots if you stop taking Xarelto too soon. Stopping treatment with Xarelto increases your risk for having a blood clot.
• Risk of spinal or epidural hematoma. Getting a spinal or epidural injection while you’re taking Xarelto could cause bleeding around your spine or brain. This could result in either a spinal or epidural hematoma. This refers to a buildup of blood around your spine or brain.

For details, see the “Side effect specifics” section above.

Other precautions

Be sure to talk with your doctor about your health history before you take Xarelto. This drug may not be the right treatment for you if you have certain medical conditions or other factors that affect your health. The conditions and factors to consider include:

• Bleeding problems. You should not take Xarelto if you have any active abnormal bleeding or an increased risk for bleeding. This may apply if you’re having cancer treatment or you have a stomach ulcer. Taking Xarelto increases your risk for bleeding. So if you have a history of bleeding problems, talk with your doctor about whether Xarelto is right for you.
• An artificial heart valve. You should not take Xarelto if you have an artificial heart valve. In a clinical trial, Xarelto increased the risk of side effects when used in people with a specific type of artificial heart valve. And Xarelto hasn’t been studied with most other types of artificial heart valves. Talk with your doctor about treatments other than Xarelto that may be safer for you.
• Kidney problems. Xarelto may build up in your body if your kidneys aren’t working well. If you have kidney problems, you may need to take a lower dosage of Xarelto than usual. Or, your doctor may recommend a different medication that’s safer for you. Talk with your doctor about whether Xarelto is safe for you to take if you have kidney problems. Xarelto usually won’t be prescribed for use in children who have kidney problems.
• Liver problems. If you have moderate to severe liver problems, you should not take Xarelto. And you should avoid taking Xarelto if you have a blood clotting condition that’s related to a liver problem. Before taking Xarelto, talk with your doctor about your history of liver problems. Xarelto typically is not prescribed for use in children who have liver problems.
• Pulmonary embolism (PE) requiring treatment to dissolve the clot. Xarelto shouldn’t be used to treat PE that needs surgery or medication to dissolve the clot. But the drug may be used to treat PE in other cases (see this article for details). If you’re taking Xarelto to treat PE, be sure to talk with your doctor about whether Xarelto is right for your specific type of PE.
• Triple-positive antiphospholipid syndrome (APS). If you have APS, taking Xarelto increases your risk for developing blood clots. Make sure that your doctor knows about your condition. They can recommend a medication other than Xarelto for you.
• Allergic reaction. You shouldn’t take Xarelto if you’ve ever had an allergic reaction to the drug or any of its ingredients. Talk with your doctor about which other treatments are better choices for you.

Alcohol use with Xarelto

Alcohol isn’t known to interact with Xarelto. However, drinking large amounts of alcohol while taking Xarelto can increase your risk for bleeding, especially in your stomach or digestive tract.

If you drink alcohol, talk with your doctor about how much is safe for you to drink while you’re taking Xarelto.

Pregnancy and breastfeeding while taking Xarelto

Pregnancy. Taking Xarelto during pregnancy can increase the risk of bleeding in both the pregnant person and the fetus. The drug can also increase the risk of pregnancy-related hemorrhage (excessive bleeding) and complications with labor and delivery.

For these reasons, blood thinners other than Xarelto are usually prescribed for use during pregnancy. But Xarelto may be prescribed during pregnancy if your doctor determines that the drug’s benefits outweigh its risks. Talk with your doctor if you become pregnant or plan to become pregnant while taking Xarelto.

Breastfeeding. Xarelto has been shown to pass into breast milk. But the drug’s potential effects on a breastfed child aren’t known. If you’re breastfeeding, be sure to talk with your doctor before you take Xarelto. They can help determine whether this is safe for you and your child.

Xarelto is approved to help prevent and treat certain blood clots. If you’d like to learn more about Xarelto, talk with your doctor or pharmacist. They can help answer any questions you have about side effects from taking the drug.

Besides talking with your doctor, you can do some research on your own. These articles might help:

• More information about Xarelto. For details about other aspects of Xarelto, refer to this article.
• Drug comparison. To learn how Xarelto compares with Eliquis, you can see this article.
• Dosage. For information about the dosage of Xarelto, view this article.
• Interactions. To find out about Xarelto’s interactions, see this article.
• Cost. For information about the cost of Xarelto treatment, you can refer to this article.
• A look at cardiovascular health. For details about the conditions Xarelto is used for, our cardiovascular health hub may be helpful.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

What Is XARELTO® | XARELTO® (rivaroxaban)

XARELTO^® is a blood thinner that treats and helps prevent blood clots that are related to
certain conditions involving the heart and blood vessels.

How does XARELTO^® work?

XARELTO^® belongs to the category of blood thinners commonly called DOACs, or direct oral anticoagulants. One thing that makes DOACs different from older blood-thinning medications is that they affect fewer factors that help to form blood clots. XARELTO^® targets just one—Factor Xa (“10a”).

What are the types of blood thinners?

There are 2 types of blood thinners—antiplatelets and anticoagulants.

Antiplatelets

Antiplatelets lower your blood’s ability to clot by preventing platelets—cell fragments in your blood—from sticking together and forming clots. Examples include aspirin, clopidogrel (Plavix^®), prasugrel (Effient^®), and ticagrelor (Brilinta^®).

Anticoagulants

Anticoagulants lower your blood’s ability to clot by stopping specific proteins and enzymes, also known as clotting factors, from doing their job to help blood clots form.

What should I know about XARELTO^®?

No known dietary restrictions while on XARELTO^®

XARELTO^® usage doesn’t require regular blood testing

XARELTO^® dosing doesn’t require frequent adjustments

XARELTO^® is taken once daily* for AFib

*Taken with the evening meal

Are there any side effects associated with XARELTO^® in adults?

Side effects of XARELTO^®:

• Increased risk of bleeding
  • You are likely to bruise more easily and it may take longer for the bleeding to stop

Your risk of bleeding increases if you take XARELTO^® with other medicines that also increase your risk of bleeding, such as:

• • Aspirin or aspirin-containing products
  • Long-term (chronic) use of non-steroidal anti-inflammatory drugs (NSAIDs)
  • Warfarin sodium (Coumadin^®, Jantoven^®)
  • Any medicine that contains heparin
• • Clopidogrel (Plavix^®)
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serotonin norepinephrine reuptake inhibitors (SNRIs)
  • Other medicines to prevent or treat blood clots

Always tell your healthcare professional if you experience any side effects while taking XARELTO^®—keeping an open and honest conversation going with your healthcare professional will help you get the best care.

To learn more about how XARELTO^® treats and helps prevent blood clots related to a specific condition, select below:

• • Adult Conditions:
  • Nonvalvular Atrial Fibrillation (AFib)
  • Deep Vein Thrombosis (DVT)
  • Pulmonary Embolism (PE)
  • Coronary Artery Disease (CAD)
• • Peripheral Artery Disease (PAD)
  • Knee and Hip Replacement
  • Non-Surgical Hospitalization
• • Pediatric Conditions:
  • Pediatric DVT/PE
  • Pediatric post Fontan

How can you save on XARELTO^®?

Find out about support options that may help with managing your out-of-pocket cost for XARELTO^®.

Get Started

Do blood thinners (anticoagulants) prevent blood clots in people hospitalized with COVID-19?

Your browser does not support audio elements.

Key messages

– High doses of “blood thinning” drugs have little or no effect on death rates and increase minor bleeding rates compared to low doses in people hospitalized with COVID-19. The use of blood thinners (anticoagulants) compared to no use may reduce the rate of death.

– It is likely that new studies will not change the evidence for the effects of different doses of “blood thinning” drugs on death rates and minor bleeding. High-quality studies are still needed to analyze the need for additional respiratory support, the use of “blood thinner” drugs versus no use, the comparison of different “blood thinner” drugs, and their long-term use.

What is COVID-19?

COVID-19 usually affects the lungs and airways, however, in addition to respiratory problems, about 16% of people hospitalized with COVID-19 have problems with the blood and blood vessels, leading to the formation of blood clots (thrombi) in the arteries, veins and lungs. Nearly half of people with severe COVID-19 in intensive care units may develop blood clots in their veins or arteries.

What are blood thinners?

Blood thinners are medicines that prevent dangerous blood clots (deep vein thrombosis) from forming. However, they can cause unwanted effects such as bleeding. Some guidelines recommend giving blood thinners the first time people with COVID-19 are admitted to the hospital to prevent clots from forming, rather than waiting for clots (blood clots) to form and then treating them with blood thinners.

What did we want to find out?

We wanted to know if the prophylactic use of blood thinners in people hospitalized with COVID-19 reduces the number of deaths compared to people who did not receive them or received a placebo (an identical treatment but without the active substance). We also wanted to know if these people needed less breathing support, if they did develop blood clots, if they were bleeding, and if they had other adverse events.

What have we done?

We searched for studies that evaluated blood thinners used in people hospitalized with COVID-19 to prevent blood clots. The studies could be of any design, as long as they compared one blood thinner to another blood thinner, or to no treatment or to a placebo (dummy). Studies could be conducted anywhere in the world, and participants could be of any age, as long as they were in a hospital with a confirmed COVID-19 disease. We have combined the results where appropriate.

What did we find?

We included seven studies involving 16,185 people admitted to intensive care units, hospital wards, or emergency departments with COVID-19. The studies were conducted in Brazil (2), Iran (1), Italy (1) and the USA (1), and two studies included participants from more than one country. The age of the people participating in the studies ranged from 55 to 68 years. The studies lasted from 15 to 90 days, their results presented data on death, bleeding, blood clots, length of hospital stay, and adverse effects. There was little or no data on the need for respiratory support (help with breathing), COVID-19 related deaths and quality of life.

Higher dose of “blood thinning” drugs than lower dose (4 studies, 4647 people)

In people who received higher doses of blood thinners compared to lower doses, there was virtually no difference in the frequency of death. However, people who took higher doses were more likely to experience minor bleeding compared to those who took lower doses. People who received higher doses of blood thinners may have had fewer cases of pulmonary embolism (a blood clot in the lungs or in a blood vessel leading to the lungs), slightly more major (more severe) bleeding, and probably had little or no there was no difference in length of stay in the hospital compared to those who received lower doses of blood thinners. People who received higher doses of blood thinners had little or no difference in the incidence of deep vein thrombosis and other adverse events compared to those who received lower doses of blood thinners.

Blood thinners versus no treatment (3 studies, 11,538 people)

Those who received blood thinners had a lower rate of death compared to those who did not, but the evidence is highly uncertain.

What are the limitations of this evidence?

We strongly believe that higher doses of blood thinners do not change the risk of death but increase the risk of bleeding in people hospitalized with COVID-19.

Although our certainty in the evidence is very limited, people who receive blood thinners may have a lower rate of death than those who do not.

What’s next?

The search identified 62 ongoing studies with 35,470 participants. We plan to add the results of these studies to our review when they are published.

How relevant is this evidence?

Evidence is current to 14 April 2021.

If you found this evidence helpful, please consider donating to Cochrane. We are a charity that produces accessible evidence to help people make health and care decisions.

Donate

Translation notes:

Translation: Airat Usmanovich Ziganshin. Editing: Ziganshina Lilia Evgenievna. Project coordination for translation into Russian: Cochrane Russia – Cochrane Russia on the basis of the Russian Medical Academy of Continuing Professional Education (RMANPE). For questions related to this transfer, please contact: [email protected]

top 5 list according to the KP version with instructions for use, doctors’ reviews, prices

The active ingredient of Xarelto is rivaroxaban. It reduces the production of the protein thrombin, with the participation of which platelets “stick together” and blood clots form. Xarelto is used to treat and prevent diseases that are accompanied by increased blood viscosity: thrombosis, thromboembolism, stroke, myocardial infarction.

List of top 5 Xarelto analogues according to KP version

Our list contains Xarelto analogues with different mechanism of action and dosage, so only a doctor can recommend a medicine that will not harm your health and provide the desired result.

Eliquis

Its active ingredient is the anticoagulant apixaban. Like rivaroxaban, it helps to “slow down” the production of the thrombin protein and prevent the formation of blood clots. Available in tablets with a dosage of 2.5 and 5 mg.

Contraindications for use: active bleeding and a tendency to them, hypersensitivity to the components of the drug, impaired renal function, pregnancy, lactation, age up to 18 years.

Pradaxa

Pradaxa contains dabigatran etexilate, a direct anticoagulant that reduces the activity of the thrombin protein and prevents the formation of blood clots. According to the mechanism of action, Pradaxa is slightly different from Xarelto, but is indicated for the same diseases. The drug is prescribed for the treatment and prevention of strokes, heart attacks, venous and systemic thromboembolism, deep vein thrombosis. Release form – capsules with a dosage of 150 mg.

Pradaxa should not be taken by pregnant and lactating women, children and adolescents under 18 years of age, people with kidney failure, liver dysfunction, active bleeding.

Warfarin

Warfarin helps block the production of proteins in the liver that increase blood clotting. As a result, the concentration of these proteins in the body decreases, and the formation of blood clots slows down. Release form – tablets 2.5 mg.

Warfarin is contraindicated in people with or with a tendency to bleed, severe liver and kidney problems, severe DIC and thrombocytopenia, and pregnant women.

Warfarex

The active ingredient of the drug is warfarin sodium, an indirect anticoagulant. Warfarex acts in the liver and helps slow down the synthesis of proteins that increase blood clotting. The drug is prescribed for the prevention and treatment of deep vein thrombosis, pulmonary embolism and myocardial infarction. Varfarex release form – tablets with a dosage of 5 mg.

The drug is contraindicated in cases of bleeding and the threat of their development, severe renal and hepatic insufficiency, hemorrhagic diathesis, thrombocytopenia, severe DIC, stroke, exacerbation of gastric and duodenal ulcers, pregnancy and age up to 18 years.

Phenylin

The mechanism of action of Phenylin is similar to that of Warfarin. The active substance phenindione reduces the production of proteins that are formed in the liver and are further involved in the formation of blood clots. It is used for the prevention and treatment of thromboembolism, thrombophlebitis, thrombosis, myocardial infarction. Available in tablets with a dosage of 30 mg.

Contraindications: should not be taken with hemorrhagic diathesis, anemia, severe kidney and liver diseases, anemia, stomach and duodenal ulcers, during pregnancy and lactation.

How to choose a Xarelto analogue

Xarelto analogue must be selected by a doctor. First of all, the doctor will take into account the reason why Xarelto was prescribed, as well as the patient’s state of health, what medications he is already taking. In most cases, before prescribing an analogue, blood tests are studied to assess the state of the coagulation system.

Frequently Asked Questions

Blood clotting is a very common problem, especially among people over 40 years of age. Therefore, the issues of taking and replacing drugs for blood thinning are of interest to many people. Our expert answers popular questions — PhD, endocrinologist, nutritionist, therapist Tatyana Gudozhnikova.

When Xarelto analogs can be used

– Xarelto analogs are used:

• for the prevention and treatment of venous thrombosis and pulmonary embolism;
• to prevent blockage of blood vessels by blood clots in hypertension, stroke, diabetes, heart failure;
• to prevent thrombosis after replacement of joints of the lower extremities and heart valves;
• in the complex therapy of patients with coronavirus infection.