Rivaroxaban – an effective drug for multiple indications and in diverse patient groups Review article
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Published:
Mar 1, 2026
Keywords:
anticoagulation, DOAC, rivaroxaban, atrial fibrillation, peripheral artery disease
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Abstract
Rivaroxaban, a direct oral anticoagulant, is used for the prevention and treatment of venous thromboembolism following episodes of deep vein thrombosis and pulmonary embolism, as well as in atrial fibrillation, and in the presence of left ventricular thrombus. It is the only direct oral anticoagulant indicated at a so-called vascular dose in combination therapy for chronic coronary syndrome and peripheral artery disease, after an acute coronary syndrome and following lower limb revascularization. Its pharmacokinetic properties, dosing and safety profile make it suitable for elderly patients and for those with chronic kidney disease. In this description, a practical neurological perspective on the use of rivaroxaban in patients in secondary prevention of ischemic stroke, as well as on the risk of bleeding events, has been incorporated.
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How to Cite
Skwarek, A., Golenia, A., & Ozierański, K. (2026). Rivaroxaban – an effective drug for multiple indications and in diverse patient groups. Medycyna Faktow (J EBM), 19(4(69), 535-541. https://doi.org/10.24292/01.MF.0425.08
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References
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9. Eikelboom JW, Connolly SJ, Bosch J et al.; COMPASS Investigators. Rivaroxaban with or without Aspirin in Stable Cardiovascular Disease. N Engl J Med. 2017; 377(14): 1319-30.
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11. Mega JL, Braunwald E, Wiviott SD et al. Rivaroxaban in Patients with a Recent Acute Coronary Syndrome. N Engl J Med. 2012; 366(1): 9-19.
12. Patel MR, Mahaffey KW, Garg J et al.; ROCKET AF Investigators. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011; 365(10): 883-91.
13. EINSTEIN–PE Investigators; Büller HR, Prins MH, Lensin AW et al. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med. 2012; 366(14): 1287-97.
14. Bonaca MP, Bauersachs RM, Anand SS et al. Rivaroxaban in Peripheral Artery Disease after Revascularization. N Engl J Med. 2020; 382(21): 1994-2004.
15. Gibson CM, Mehran R, Bode C et al. Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI. N Engl J Med. 2016; 375(25): 2423-34.
16. Akao M, Yasuda S, Kaikita K et al. Rivaroxaban monotherapy versus combination therapy according to patient risk of stroke and bleeding in atrial fibrillation and stable coronary disease: AFIRE trial subanalysis. Am Heart J. 2021; 236: 59-68.
17. Summary of product characteristics. Xarelto.
2. Steffel J, Collins R, Antz M et al. 2021 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation. Europace. 2021; 23(10): 1612-76.
3. Halperin JL, Hankey GJ, Wojdyla DM et al. Efficacy and safety of rivaroxaban compared with warfarin among elderly patients with nonvalvular atrial fibrillation in the Rivaroxaban Once Daily, Oral, Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF). Circulation. 2014; 130(2): 138-46.
4. Prins MH, Lensing AW, Bauersachs R et al. Oral rivaroxaban versus standard therapy for the treatment of symptomatic venous thromboembolism: a pooled analysis of the EINSTEIN-DVT and PE randomized studies. Thromb J. 2013; 11(1): 21.
5. Burness CB, Perry CM. Rivaroxaban: a review of its use in the treatment of deep vein thrombosis or pulmonary embolism and the prevention of recurrent venous thromboembolism. Drugs. 2014; 74(2): 243-62.
6. Weitz JI, Lensing AWA, Prins MH et al. Rivaroxaban or Aspirin for Extended Treatment of Venous Thromboembolism. N Engl J Med. 2017; 376(13): 1211-22.
7. Shah Jehangir A, Hussain J, Ahmed B et al. Rivaroxaban vs Warfarin in Acute Left Ventricular Thrombus Following Myocardial Infarction. JACC: Advances. 2025; 4(8): 101978.
8. Vrints C, Andreotti F, Koskinas KC et al. 2024 ESC Guidelines for the management of chronic coronary syndromes: Developed by the task force for the management of chronic coronary syndromes of the European Society of Cardiology (ESC) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2024; 45(36): 3415-537.
9. Eikelboom JW, Connolly SJ, Bosch J et al.; COMPASS Investigators. Rivaroxaban with or without Aspirin in Stable Cardiovascular Disease. N Engl J Med. 2017; 377(14): 1319-30.
10. Mazzolai L, Teixido-Tura G, Lanzi S et al. 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases: Developed by the task force on the management of peripheral arterial and aortic diseases of the European Society of Cardiology (ESC) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS), the European Reference Network on Rare Multisystemic Vascular Diseases (VASCERN), and the European Society of Vascular Medicine (ESVM). Eur Heart J. 2024; 45(36): 3538-700.
11. Mega JL, Braunwald E, Wiviott SD et al. Rivaroxaban in Patients with a Recent Acute Coronary Syndrome. N Engl J Med. 2012; 366(1): 9-19.
12. Patel MR, Mahaffey KW, Garg J et al.; ROCKET AF Investigators. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011; 365(10): 883-91.
13. EINSTEIN–PE Investigators; Büller HR, Prins MH, Lensin AW et al. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med. 2012; 366(14): 1287-97.
14. Bonaca MP, Bauersachs RM, Anand SS et al. Rivaroxaban in Peripheral Artery Disease after Revascularization. N Engl J Med. 2020; 382(21): 1994-2004.
15. Gibson CM, Mehran R, Bode C et al. Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI. N Engl J Med. 2016; 375(25): 2423-34.
16. Akao M, Yasuda S, Kaikita K et al. Rivaroxaban monotherapy versus combination therapy according to patient risk of stroke and bleeding in atrial fibrillation and stable coronary disease: AFIRE trial subanalysis. Am Heart J. 2021; 236: 59-68.
17. Summary of product characteristics. Xarelto.