Xarelto dosing for DVT

In this article:

• What is Xarelto prescribed for?
• 1. Initial treatment dose
• 2. Six-month maintenance dose
• 3. Ongoing preventive dose
• Xarelto vs. alternatives for DVT
• Safety considerations when taking Xarelto for DVT

In this article

• What is Xarelto prescribed for?
• 1. Initial treatment dose
• 2. Six-month maintenance dose
• 3. Ongoing preventive dose
• Xarelto vs. alternatives for DVT
• Safety considerations when taking Xarelto for DVT

Xarelto (rivaroxaban) is a brand-name prescription blood thinner that’s approved by the Food and Drug Administration to treat deep vein thrombosis (DVT) and several other conditions. Typical Xarelto dosing for DVT starts at one 15 mg oral tablet twice per day (a total of 30 mg daily) to stop existing clots from getting bigger and to prevent future clots. The Xarelto dose is gradually decreased for ongoing clot prevention. In this guide, we’ll explain the dosing schedule most healthcare providers follow when prescribing Xarelto for DVT. 

What is Xarelto prescribed for?

Xarelto is FDA approved to treat the following:

• Deep vein thrombosis, a blood clot that forms in a vein buried “deep” within a muscle, often in a leg
• Pulmonary embolism (PE), a condition where a blood clot breaks loose, travels to the lungs, and blocks an artery
• DVT and PE (collectively known as venous thromboembolism or VTE) in people younger than 18 years who have already received another type of fast-acting blood thinner called a “parenteral anticoagulant” for at least five days

Xarelto has FDA approval to prevent the following:

• DVT and subsequent PE in people getting knee or hip replacement surgery
• VTE in people with short-term illnesses
• Blood clots in people 2 years and older who have received the Fontan procedure for congenital heart disease

The FDA has also approved Xarelto to reduce the risk of the following:

• Stroke and systemic embolism (traveling blood clots) in people with nonvalvular atrial fibrillation (a type of rapid, irregular heartbeat that isn’t caused by a problem in the heart valves)
• Recurring DVT or PE
• Recurring VTE in people younger than 18 years
• Major adverse cardiovascular events (e.g., heart attack, stroke, or heart-related death) in people with coronary artery disease 
• Major thrombotic vascular events (e.g., heart attack, stroke, DVT, or PE) in people with peripheral artery disease 

Healthcare providers sometimes prescribe Xarelto off-label. Studies suggest it’s a relatively safe and effective treatment for superficial vein thrombosis (a blood clot that forms in veins closer to the skin) and chronic thromboembolic pulmonary hypertension (high blood pressure in the lungs caused by clots that scar over) except in people with a mechanical heart valve or restricted blood flow in certain areas of the heart.

Elizabeth Rubin Ribak, a clinical adviser at Embers Recovery in Phoenix, Arizona, says Xarelto is also sometimes used to treat left ventricular thrombus (a blood clot that forms in a specific area of the heart), antiphospholipid syndrome (blood clots caused by antibodies that erroneously target certain fats), cerebral venous sinus thrombosis (a blood clot that forms in a vein leading away from the brain), and peripheral artery disease (narrow arteries leading to the legs and arms). 

Xarelto dosing for DVT

Xarelto dosing for DVT is split into three phases: a three-week initial treatment dose, a six-month maintenance dose, and an optional long-term preventive dose. 

The Xarelto doses provided below reflect the manufacturer’s guidelines and aren’t right for everyone. Your healthcare provider may need to adjust the dose of Xarelto if you’re pregnant or have certain conditions, like kidney disease.

1. Initial treatment dose

The initial Xarelto treatment phase lasts 21 days (three weeks). There’s a high risk of experiencing a second blood clot within 21 days of the first deep-vein clot, which is why a more aggressive treatment is prescribed during this time.

Bayer HealthCare AG and Janssen Pharmaceuticals, Inc., the manufacturers of Xarelto, recommend a starting dose of one 15 mg tablet twice per day, for a total of 30 mg per day. 

RELATED: How much is Xarelto without insurance?

2. Six-month maintenance dose

Once you’re past the high-risk phase, your healthcare provider may lower the dose of Xarelto for about six months. It can take that long for existing blood clots to dissolve, and Xarelto ensures the clot doesn’t get any bigger while simultaneously preventing additional clots.

The typical Xarelto dose during this stage is one 20 mg tablet taken once per day. 

3. Ongoing preventive dose (if recommended by your healthcare provider)

People who experience an unprovoked DVT (a blood clot with no known cause) have about a 22% chance of developing another clot if they stop taking an anticoagulant like Xarelto. The risk increases each year.

Therefore, your healthcare provider may keep you on Xarelto long-term to prevent future blood clots. Xarelto dosing for DVT prophylaxis (prevention) may be one 10 mg tablet or one 20 mg tablet once per day, depending on your health history and risk factors.

Note that not everyone needs to take Xarelto long-term. Provoked DVTs (those with a known cause, such as surgery or trauma) are less likely to happen again. In these cases, Xarelto may be discontinued after six months if your healthcare provider recommends doing so.

Xarelto vs. alternatives for DVT

Xarelto belongs to a class of drugs called factor Xa inhibitors, which work by blocking a clotting protein called factor Xa. Eliquis (apixaban) is another popular DVT medication in this drug class.

Other Xarelto alternatives include the vitamin K antagonist Coumadin (warfarin) and direct thrombin inhibitors like Pradaxa (dabigatran). 

According to Dr. Rubin Ribak, the advantages of Xarelto include:

• Convenient oral dosing 
• Fast onset
• No routine blood monitoring
• Predictable effects

Toni Reincke, owner of Reincke Vein Center in Sugar Land, Texas, adds that Xarelto isn’t typically affected by foods and has fewer interactions with other medications and supplements. In contrast, the popular anticoagulant warfarin requires a diet consistent in vitamin K and is associated with about 500 possible drug interactions. Warfarin also requires frequent blood monitoring. 

Disadvantages of Xarelto include a high risk of bleeding, although bleeding can occur with any blood thinner. Brain bleeding can occur after an epidural or lumbar puncture. Eliquis has a lower risk of bleeding than Xarelto.

Your health care provider will consider the potential side effects and contraindications of each medication before prescribing a DVT treatment.  

Safety considerations when taking Xarelto for DVT

Xarelto shouldn’t be taken by people with active pathological bleeding and is not recommended for use in people with prosthetic heart valves. Tell your healthcare provider about any medical conditions you have, as well as your medical and surgical history, including if you have liver or kidney problems, antiphospholipid syndrome, or are pregnant or breastfeeding. Also tell your provider if you have a history of numerous spinal punctures or spinal surgery. 

Studies also suggest that Xarelto shouldn’t be taken with drugs known as strong CYP3A4, P-gp, and Bcrp inhibitors because they can affect how the body processes and eliminates the medication. Be sure to tell your healthcare provider about all the medicines you take, including prescription and OTC drugs, vitamins, and supplements.

To improve the absorption of Xarelto, take it with food—ideally with your evening meal. 

Blood clots can occur if Xarelto isn’t taken exactly as prescribed. What do you do if you miss a dose of Xarelto? 

• For adults, if you take Xarelto once a day, take the missed dose as soon as you remember, if it’s the same day. Go back to your regular schedule on the next day. 
• If you take Xarelto twice a day to treat DVT, take the missed dose as soon as you remember on that day. You can take two doses at the same time to make up for the missed dose. Go back to your regular schedule on the next day. 
• If you have coronary or peripheral artery disease and you take Xarelto twice a day to reduce the risk of DVT, and miss a dose, continue your regular schedule—do not take a double dose. 

If you’re not sure what to do, check with your healthcare provider. 

Call in refills to your pharmacy a few days early—don’t wait until the last minute. If there’s a delay in refilling your prescription, be sure to ask the pharmacy for an emergency 72-hour supply. In the event of a Xarelto shortage, talk to your healthcare provider right away about starting another anticoagulant.    

Falling is especially dangerous while taking Xarelto due to the risk of internal bleeding, so seek medical attention right away if you fall or are in any kind of accident. You may also notice more bruises than usual. Talk to your healthcare provider if any bruises are especially large and painful, show signs of infection (like heat and swelling), or seem to get bigger instead of healing. 

Seek emergency care if you notice any of the following, as it could be a sign of internal bleeding, a new blood clot, or an allergic reaction to Xarelto:

• Blood in stool, urine, or vomit (may look brown, black, tarry, or have the appearance of coffee grounds)
• Coughing up blood 
• Nosebleeds that last longer than 10 minutes
• Excessive menstrual bleeding
• Excessive gum bleeding
• Unexplained pain or swelling in the abdomen, back, legs, or arms
• Numbness or a pins-and-needles feeling in your legs and feet
• Muscle weakness
• Dizziness
• Headache
• Fatigue
• Itching, rash, or hives
• Swelling of the face, tongue, or throat
• Difficulty breathing or swallowing

Bottom line

In people with DVT, Xarelto is initially prescribed at 30 mg per day (15 mg twice daily) to prevent existing blood clots from growing and stop new clots from forming. After the greatest risk of blood clot formation has passed, the dose is usually decreased by the healthcare provider to 20 mg per day for ongoing prevention. Depending on what caused the initial blood clot, some people may continue to take Xarelto indefinitely, while others can stop the medication after about six months. Your healthcare provider will guide you on how to take Xarelto for your condition. 

Xarelto is effective when taken as prescribed. Taking too much or too little Xarelto increases the risk of side effects like severe bleeding and recurring blood clots. Don’t change the Xarelto dose or stop it completely without talking to a healthcare professional.