Atrial fibrillation (AFib) is a common heart rhythm problem. It happens when the upper chambers of the heart beat in an irregular and often rapid way. AFib becomes more common with age, especially in adults older than 65.
One of the biggest concerns with AFib is stroke. When the heart does not beat normally, blood can collect in the upper chambers of the heart and form clots. If a clot travels to the brain, it can block blood flow and cause a stroke. If you or a loved one has AFib, your health care provider may prescribe a medicine to help prevent stroke.
Xarelto (rivaroxaban) is a prescription medicine that helps lower the risk of stroke and blood clots in people with nonvalvular AFib — a type of AFib not caused by a problem with a heart valve. Xarelto belongs to a group of medicines called anticoagulants, also known as blood thinners.
For a long time, warfarin was the most common blood thinner for people with AFib, but it often requires frequent blood tests and dose changes, and can also interact with certain foods and medicines. Xarelto is one of several newer blood thinners that do not require routine blood clotting tests.
Xarelto is also used to treat or prevent blood clots in other situations. This article focuses on how Xarelto works for AFib, how to take it, and how it was studied in clinical trials. You may also be interested in reading about possible Xarelto side effects and interactions.
How Does Xarelto Work for AFib?
Atrial fibrillation can raise the risk of blood clots forming inside the heart. If a clot breaks loose and travels through the bloodstream, it can block blood flow to the brain and cause a stroke. Blood clots can also travel to other parts of the body and block blood vessels, a problem called systemic embolism.
Xarelto works by blocking a clotting protein called factor Xa. Factor Xa plays an important role in the body’s clotting process. By slowing down the activity of factor Xa, Xarelto makes it harder for harmful blood clots to form. However, it also increases the risk of bleeding. Your health care provider can discuss the possible risks and benefits of Xarelto with you.
What Is the Dosage of Xarelto for AFib?
Always take Xarelto exactly as prescribed by your health care provider.
The typical Xarelto dosage for AFib is 15 milligrams (mg) or 20 mg taken once daily with the evening meal. The exact dose depends on how well your kidneys work, so your provider may check your kidney function before and during treatment.
Xarelto is usually a long-term treatment for people with AFib. Do not stop taking Xarelto without first talking to your health care provider. Stopping Xarelto too soon can increase your risk of having a blood clot, stroke, or other serious complications.
If you need surgery, a medical procedure, or a switch to another blood thinner, your health care provider may tell you when and how to stop Xarelto safely and when to restart treatment. If you think you need to stop taking Xarelto for any reason, contact your health care provider for guidance before making any changes.
How Was Xarelto Studied for AFib?
Xarelto was studied in a clinical trial called ROCKET AF. The study compared Xarelto with warfarin, another medicine used to reduce the risk of stroke in people with nonvalvular AFib.
To qualify for the study, participants had to have nonvalvular AFib plus at least one major risk factor for stroke, such as:
- A previous stroke, mini-stroke, or blood clot outside the brain
- Age 75 years or older
- High blood pressure
- Heart failure
- Diabetes
More than 14,000 adults (60% men and 40% women) participated in the study. At the start of the study:
- The average age of participants was 71 years.
- More than half of participants (55%) had already experienced a stroke, mini-stroke, or another type of blood clot in the past.
- Some people (37%) were already taking low-dose aspirin.
The study was conducted in many countries around the world. Most participants (83%) were White, 13% were Asian, and around 1% were Black.
Participants were randomly assigned to take either Xarelto or warfarin, and neither the participants nor the researchers knew which treatment each person received until the study ended.
The goal of the study was to see how well Xarelto worked for preventing strokes and blood clots that traveled to other parts of the body (systemic embolism). To measure this, the researchers kept track of how long it took before a participant experienced their first stroke or systemic embolism.
What Are the Benefits of Xarelto for AFib Based on Studies?
Overall, the ROCKET AF study found that Xarelto was at least as effective as warfarin at lowering the risk of stroke and blood clots in adults with nonvalvular AFib.
The table below summarizes the results. The percentages represent the portion of people who experienced each outcome during the study.
| Xarelto | Warfarin | |
|---|---|---|
| Stroke or systemic embolism (main result) | 3.8% | 4.3% |
| Stroke | 3.6% | 4.0% |
| Systemic embolism | 0.3% | 0.4% |
These results show that Xarelto worked about as well as warfarin at preventing strokes and blood clots that traveled to other parts of the body. The study showed that Xarelto was not better than warfarin but was just as effective.
Xarelto worked similarly well across different groups of patients with AFib, including those with different medical histories, ages, and stroke risk factors.
Your results may differ from those seen in the study.
Is There Any Cost Assistance Available for Xarelto?
A cost assistance program is available from Johnson & Johnson, the manufacturer of Xarelto. It may reduce the amount you pay. Whether you qualify to enroll may depend on what type of insurance you have or if you are uninsured. Visit this website to see if you’re eligible for copay savings. You can also call 888-927-3586 to learn more about financial support options.
