rivaroxaban

Overview

Rivaroxaban is an oral anticoagulant used in the prevention and treatment of thromboembolic disease. It belongs to the class of direct oral anticoagulants (DOACs) and acts by selectively inhibiting factor Xa, a key enzyme in the coagulation cascade that promotes thrombin generation and fibrin clot formation. By reducing factor Xa activity, rivaroxaban lowers the blood’s ability to clot and is used in a range of cardiovascular and thrombosis-related settings.

Clinically, rivaroxaban is relevant in conditions such as non-valvular atrial fibrillation, venous thromboembolism, and selected high-risk cardiovascular populations where anticoagulation is indicated. Its use is also closely tied to bleeding management and reversal strategies, including the use of andexanet alfa in severe hemorrhage. In recent research, rivaroxaban has also been studied alongside apixaban and aspirin in comparative effectiveness, dual-pathway inhibition, and pharmacokinetic interaction contexts.

Focus of Latest Publications

Recent publications on rivaroxaban have focused on its role in anticoagulation across cardiovascular, peripheral vascular, oncology, and pharmacokinetic settings, as well as on reversal strategies for bleeding. In atrial fibrillation and chronic coronary syndrome, rivaroxaban was evaluated alongside other antithrombotic approaches in comparative and guideline-oriented analyses. One study assessed the cost-effectiveness of apixaban versus warfarin, dabigatran, edoxaban, and rivaroxaban for non-valvular atrial fibrillation from the Belgian payer perspective, while a COMPASS substudy examined the net clinical benefit of extended dual pathway inhibition with aspirin and rivaroxaban in chronic coronary syndrome according to the 2024 ESC high-risk criteria.

Several publications addressed rivaroxaban use after vascular intervention and in real-world practice. A retrospective cohort study was designed to evaluate low-dose rivaroxaban, reflecting the VOYAGER PAD regimen of 2.5 mg twice daily, following peripheral vascular intervention for peripheral artery disease, with the abstract noting that the clinical trial evidence showed reduced major adverse limb events but increased bleeding. Another real-world study specifically investigated the effectiveness and safety of low-dose rivaroxaban after peripheral arterial endovascular revascularization. These reports indicate continued interest in how trial-based rivaroxaban strategies translate into routine care.

Other studies examined rivaroxaban in drug interaction and formulation contexts. In healthy volunteers, sotorasib was tested for its effect on the pharmacokinetics of a single 20 mg dose of rivaroxaban, and the study found no clinically relevant pharmacokinetic interaction, with both drugs well tolerated. Separately, a modeling study used published plasma concentration-time profiles of rivaroxaban orally disintegrating tablets to derive absorption-delay functions and predict delayed absorption under fed conditions without water; the framework reproduced observed rivaroxaban ODT profiles and yielded predicted Tmax and Cmax values consistent with reported data.

Rivaroxaban also appeared in publications related to anticoagulant reversal and bleeding management. One report described emergency reversal of rivaroxaban with andexanet alfa in a child with hemorrhagic brain metastasis from Wilms tumor, highlighting the lack of pediatric reversal guidelines. Another study examined trends and variation in the use of andexanet alfa across NHS trusts in England, noting that NICE had recommended it as an option for life-threatening gastrointestinal bleeding in patients taking apixaban or rivaroxaban, while guidance for intracranial hemorrhage remained unresolved. Together, these publications reflect ongoing work on rivaroxaban’s comparative effectiveness, real-world use, pharmacokinetics, and reversal in urgent bleeding scenarios.

Key Publications

Jun Cost-effectiveness analysis of apixaban compared with other oral anticoagulants for the treatment of non-valvular atrial fibrillation in a Belgian healthcare setting. (Journal of medical economics, 2026, PMID 42223336): "This study assessed the cost-effectiveness of apixaban versus warfarin, dabigatran, edoxaban, and rivaroxaban for patients with NVAF from the Belgian payer perspective."
Jun Predicting plasma concentration-time profiles of orally disintegrating tablets with delayed absorption under fed conditions without water. (International journal of pharmaceutics, 2026, PMID 42082063): "Absorption-delay functions were derived from published individual plasma concentration-time profiles of rivaroxaban ODTs using a numerically stable, matrix-based non-negative least-squares deconvolution method."
May Emergency reversal of Rivaroxaban with Andexanet alfa in a child with hemorrhagic brain metastasis from Wilms tumor. (Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery, 2026, PMID 42069956): "...when patients are receiving a direct oral anticoagulant (DOAC) like Rivaroxaban, for which pediatric reversal guidelines are lacking."
Mar Effectiveness and safety of rivaroxaban following peripheral arterial endovascular revascularization in real-world practice. (Journal of vascular surgery, 2026, PMID 41786009): "The VOYAGER PAD clinical trial demonstrated that low-dose rivaroxaban (LDR; 2.5 mg twice daily) reduces major adverse limb events (MALE) at the expense of increased bleeding rates in patients undergoing lower extremity revascularization for peripheral artery disease (PAD)."
Apr Abelacimab vs Rivaroxaban in Older Individuals With Atrial Fibrillation: A Prespecified Analysis of the Phase 2b AZALEA-TIMI 71 Trial. (JAMA cardiology, 2026, PMID 41637102): "Abelacimab vs Rivaroxaban in Older Individuals With Atrial Fibrillation: A Prespecified Analysis of the Phase 2b AZALEA-TIMI 71 Trial."
May Net clinical benefit of extended dual pathway inhibition in chronic coronary syndrome as classified by the 2024 ESC criteria: a COMPASS substudy. (European heart journal. Cardiovascular pharmacotherapy, 2026, PMID 41614385): "Extended dual pathway inhibition (DPI) with aspirin and rivaroxaban is recommended in high-risk patients with chronic coronary syndrome (CCS)."
Jun No relevant pharmacokinetic interaction between the KRAS G12C inhibitor sotorasib and the direct oral anticoagulant rivaroxaban in healthy subjects. (International journal of cancer, 2026, PMID 41552958): "Consequently, anticoagulants such as rivaroxaban are often prescribed."
Jun Trends and variation in the use of andexanet alfa for the reversal of direct oral anticoagulants in NHS trusts in England. (British journal of clinical pharmacology, 2026, PMID 41406988): "Andexanet alfa was recommended by the National Institute for Health and Clinical Excellence (NICE) as an option in the management of life-threatening gastrointestinal bleeding in patients taking apixaban or rivaroxaban in May 2021."