What is Xarelto, and How Does it Work?

Thursday 13 February 2020
Xarelto

I. Xarelto Purpose and Function

II. What is a Blood Blot?

III. Why is Xarelto Used? Reasons for a Prescription

a. Xarelto May Prevent Blood Clots After Knee or Hip Replacement Surgery

b. Xarelto for Patients with Non-Valvular Atrial Fibrillation

c. Xarelto, Aspirin, and Cardiac Health

IV. Non-Medicinal Ingredients in Xarelto

V. Side Effects

VI. Precautions

a. Medical History

b. Dental and Medical Procedures

c. Alcohol

d. Activities to Avoid

e. Pregnancy

f. Warnings

g. Drug Interactions


Xarelto Purpose and Function

Xarelto is the brand name for a drug called Rivaroxaban. Xarelto belongs to a class of medications called anticoagulants (“anti” means against and “coagulant” means clotting), also known as blood thinners.

A class of drugs is a grouping of medications that are often used to treat similar conditions. Anticoagulants are a form of medicine that prevents blood from clotting. Xarelto is a prescription drug that comes as an oral tablet and is not available as a generic drug. 

Xarelto works by blocking a substance called factor Xa. When factor Xa is blocked, thrombin decreases. Thrombin is an enzyme in the blood that promotes blood clotting. Therefore, when factor Xa is blocked, thrombin decreases, and this helps to prevent blood clots. [1]

What is a Blood Clot?

image of red blood cell

A blood clot is a clump of blood cells that have changed from a liquid, blood's natural state, to a solid or semisolid. Clotting is a necessary process that can be helpful in some cases, such as when you get a scrape or cut.

Sometimes blood clots can become dangerous or life-threatening, primarily if one has formed inside a vein or artery. Blood clots inside a vein don't always dissolve on their own. Some blood clots do not move, but there's still a chance that a blood clot may break free. When a blood clot breaks free, it can get stuck and block blood flow to a particular area — this is a medical emergency, and you should contact a doctor immediately. [2]

Why is Xarelto Used? Reasons for a Prescription

There are a few reasons why someone would be given a prescription for Xarelto.

Photo of a pharmacy sign

a. Xarelto May Prevent Blood Clots After Knee or Hip Replacement Surgery

Your hips and knees are the largest joints in the body that support you throughout your life. These joints help us to walk, sit, and move with ease. Over time or due to injury, our joints begin to wear and tear. Although physical therapy or pain relief medication may provide temporary relief, some may eventually need surgery to replace a hip or knee joint. [3]

While you are unable to walk post knee or hip surgery, the risk of blood clots may increase. Xarelto is used to prevent blood clots in people who have had recent knee or hip replacement surgery.

Specifically, Xarelto is used to prevent (or treat) deep venous thrombosis (DVT). In DVT, blood clots form the vessels in the legs. When a DVT clot becomes loose, it can travel to the lungs and cause a blockage. This blockage in the blood vessels of the lungs is called a pulmonary embolism (PE). Xarelto may be used for several days after surgery to prevent a DVT or PE. [4]

Xarelto may also be used to treat DVT or PE shall they occur and for the reduction in the risk of recurrence. Xarelto reduces the risk of blood clots happening again.

b. Xarelto for Patients with Non-Valvular Atrial Fibrillation

Xarelto can be prescribed to patients with specific heart rhythm problems or an irregular heartbeat. Non-valvular atrial fibrillation (AF) is a type of heart rhythm problem in which Xarelto may be used. Xarelto is used in this instance to prevent stroke and blood clots. [5]

c. Xarelto, Aspirin, and Cardiac Health

Xarelto can be prescribed on its own to patients with certain cardiovascular diseases (CVDs), such as coronary artery disease (CAD) or peripheral artery disease (PAD). CAD is a condition characterized by a blockage or reduction of blood supply to the heart, and in PAD, blood flow to the legs is reduced. The prescription of Xarelto to high-risk CVD patients aims to reduce their risk of major heart problems, such as heart attack or stroke. [1]

Sometimes Xarelto is prescribed alongside Aspirin, a non-steroidal anti-inflammatory drug (NSAID). Aspirin functions by inhibiting a specific substance in your body to help reduce pain, swelling, and general inflammation. Xarelto and Aspirin work together to decrease the risk of severe heart problems, heart attack, and stroke in patients with CAD and PAD. 

Use caution if pairing Xarelto and Aspirin together, as directed by a doctor. Both of these medications work to thin the blood and prevent blood clots, and there is a risk that your blood may become too thin. Thin blood may increase your risk of side effects, especially the likelihood of increased bleeding. 

Non-Medicinal Ingredients in Xarelto

Prior to taking a drug, it is important to notify your doctor of any allergies you may have. Although you may not be allergic to the drug itself, it is possible to have an allergy to any of the non-active ingredients in a medication. Non-medicinal ingredients in Xarelto may include:

  • cellulose microcrystalline
  • croscarmellose sodium
  • ferric oxide red
  • ferric oxide yellow
  • hypromellose
  • lactose monohydrate
  • magnesium stearate
  • polyethylene glycol
  • sodium lauryl sulfate
  • titanium dioxide [6]

Side Effects of Xarelto

Because Xarelto is an anticoagulant, taking the drug may increases your risk of having bleeding complications. Some side effects of Xarelto may include:

  • Small bruises, bruising more easily
  • Joint or back pain
  • Bleeding that takes longer to stop such as slight gum bleeding after brushing teeth
  • Bowel or bladder dysfunction, incontinence ( loss of control of bladder or bowels)
  • Burning, itching, numbness, “pins and needles” feeling
  • Dizziness
  • Headache
  • Difficulty breathing or swallowing
  • Muscle weakness, Leg weakness
  • Paralysis
  • Major bleeding is rare (but may be as high as 1 person out of 100 each year)
  • Severe bleeding
  • Frequent nosebleeds, bleeding from gums
  • Coughing up blood
  • Red or black, tarry stools
  • Red, pink, or dark brown urine
  • Vomiting blood, or vomit that looks like coffee grounds
  • Pain, swelling, or new drainage at wound sites

Precautions

Medical History

Elderly woman speaking to a physician

It's important to speak with your doctor before beginning this medication. Tell your doctor if you are allergic to Xarelto or if you have any other allergies. Although you may not be allergic to the drug itself, it may contain inactive ingredients that can cause allergic reactions. 

Tell your doctor or pharmacist your medical history, especially of the following:

  • Liver disease
  • Kidney Disease
  • Bleeding Problems (bleeding of the stomach, intestines, or brain)
  • Stroke
  • Recent major surgery or injury
  • Blood disorders (especially anemia, hemophilia, thrombocytopenia)
  • Frequent falls or injuries
  • Eye problems (retinopathy)
  • Clotting disorder (antiphospholipid syndrome)
  • Hereditary enzyme problems (galactose intolerance, Lapp lactase deficiency, glucose-galactose malabsorption)

Dental and Medical Procedures

Before undergoing any dental procedures or forms of surgery, inform your doctor and dentist that you are using this medication. Health professionals must know you are taking this drug to prevent unwanted side effects.

Alcohol

Two friends sitting at table with many beers

While taking Xarelto, it's recommended to limit or refrain from consuming alcoholic beverages. The use of this drug may cause stomach bleeding. If you consume alcohol daily while taking this medication, the risk of stomach bleeding increases. If you are unsure, speak with your doctor about an amount of alcohol that may be safe to drink.

Activities to Avoid

Because Xarelto is an anticoagulant, the blood may become thinner. This drug can cause bleeding. It's helpful to lower your chances of getting cut, injured, or bruised. When using sharp objects like scissors, razors, nail cutters, and knives when cooking, be cautious to avoid accidental injury.

Xarelto has been known to increase bleeding of the gums. Avoid brushing the teeth aggressively. Instead, try using a soft electric toothbrush when brushing teeth.

Any contact sports should be completely avoided to minimize injury risk. If you fall or injure yourself (especially if you hit your head), contact your doctor immediately. Even if you feel okay, your doctor must check for hidden bleeding that may be serious.

Pregnancy

During pregnancy, this medication should only be used if extremely necessary. Talk to your doctor if you are pregnant or have plans to become pregnant. Risks and benefits should be weighed and spoken about with your doctor before use. Breast-feed with caution as this drug may pass into breast milk. Consult a doctor before you start breast-feeding. [7]

Warnings

Xarelto has black box warnings, which are the most serious warnings. The black box warnings alert patients and doctors about potential side effects and dangers of taking the drug. Please inform yourself of all side effects and dangers before taking the drug and always consult a doctor for questions concerning your prescription. 

Drug Interactions

Image from above of different medications separated

A drug interaction is a reaction between two (or more) drugs. A drug interaction can also involve a reaction between a drug and a food, beverage, or supplement. Taking medication while having certain medical conditions may also cause a drug interaction. Drug interactions can make a drug less effective, increase the strength or action of a drug, or cause unwanted side effects. [8]

The content in this article is intended for informational purposes only. This website does not provide medical advice. In all circumstances, you should always seek the advice of your physician and/or other qualified health professionals(s) for drug, medical condition, or treatment advice. The content provided on this website is not a substitute for professional medical advice, diagnosis or treatment.