Key takeaways:
Xarelto (rivaroxaban) is a blood thinner used to treat and prevent unwanted blood clots. It starts working within 2 to 4 hours of your first dose.
Xarelto stays in your system for about 1 to 2 days once you stop taking it. So if you’re having surgery or a procedure that’s likely to cause bleeding, you’ll typically stop taking Xarelto at least 24 hours beforehand.
How long you take Xarelto depends on the reason you’re taking it. Your prescriber will let you know if and when it’s safe to stop taking it. You shouldn’t stop taking Xarelto on your own.
There are many ways to save on Xarelto. If you’re eligible, a manufacturer savings card can help you get Xarelto for as little as $10 per prescription. A patient assistance program is also available.
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Xarelto (rivaroxaban) is a blood thinner that treats and prevents unwanted blood clots. But how long does Xarelto stay in your system, and how long do you need to take it?
Below, we’ll answer seven common questions about Xarelto. Keep in mind that you can always reach out to your pharmacist or prescriber if you have questions that aren’t covered here.
1. How long does Xarelto stay in your system?
For most people, it takes 1 to 2 days after your last dose to clear Xarelto from your body. That’s why it’s best to stop taking Xarelto at least 24 hours before a surgery or procedure that’s likely to cause bleeding.
This calculation is based on Xarelto’s half-life of 5 to 9 hours. A half-life is the amount of time it takes to clear 50% (half) of a medication from the body. Typically, it takes about five half-lives to fully clear a medication.
Xarelto may stay in your system longer if you have kidney or liver issues or you’re over age 65. Your liver and kidneys clear Xarelto from the body. So, any health conditions that slow down kidney or liver function can make Xarelto stay in your system longer.
2. How does Xarelto work?
Xarelto belongs to a class of medications known as direct-acting oral anticoagulants (DOACs). It works by blocking a protein in your blood (factor Xa) that’s involved in forming blood clots. Blocking factor Xa helps prevent blood clots from forming.
Unlike warfarin (Coumadin, Jantoven), Xarelto doesn’t require frequent blood tests or careful meal planning. This makes Xarelto a more convenient option for many people.
Good to know: When we talk about unwanted blood clots, we’re not talking about a clot that forms to stop bleeding after an injury, such as when you cut your finger. Unwanted blood clots form when there isn’t an injury. If this happens in a vein, it’s called a deep vein thrombosis (DVT). If it happens in the lungs, it’s called a pulmonary embolism (PE).
3. How long does it take Xarelto to work?
Xarelto starts to work within a few hours of your first dose. It takes 2 to 4 hours to reach its highest levels in your blood after you take it. Unlike some other blood thinners, it doesn’t take several days for Xarelto to build up in your body.
You’ll typically take Xarelto once a day. It comes in 2.5 mg, 10 mg, 15 mg, and 20 mg tablets. It’s best to take the 15 mg and 20 mg tablets with food. This helps your body absorb the medication so it can start working as expected. But you can take lower doses of Xarelto with or without food. The body absorbs lower doses well either way.
4. How long do you have to take Xarelto?
How long you take Xarelto depends on why you’re taking it. In some cases, you may only take Xarelto for a short time. In others, Xarelto may be a lifetime medication.
Below is a chart with the recommended treatment length of Xarelto by condition. Keep in mind that the amount of time you take Xarelto may differ. Your prescriber will decide what’s best for your specific needs, so be sure to follow their directions.
Condition | Length of treatment |
|---|---|
To prevent DVT after knee replacement surgery | 12 days |
To prevent DVT after hip replacement surgery | 35 days |
To prevent DVT or PE in people with a recent hospital stay | 31 to 39 days |
To treat DVT or PE | At least 3 months |
To prevent blood clots in people with atrial fibrillation (an irregular heartbeat) | Long term |
To lower the risk of heart problems due to coronary artery disease | Long term |
Keep in mind: You shouldn’t stop taking Xarelto on your own. If you stop taking it too soon, your risk of blood clots goes up. This could lead to a life-threatening health event, such as a stroke. Your prescriber will let you know if and when it’s OK to stop taking Xarelto.
5. Can you switch from warfarin to Xarelto?
In some cases, you may be able to switch from warfarin to Xarelto, but not always. Warfarin is a preferred treatment option for certain people, such as those with a mechanical heart valve. But if your prescriber OKs it, you can switch from warfarin to Xarelto.
Xarelto side effects: Learn more about possible Xarelto (rivaroxaban) side effects, how to manage them, and when to seek medical care.
Blood thinner 101: Curious about the difference between antiplatelet versus anticoagulant medications? We’ve got you covered.
Signs of bleeding: How to recognize the signs and symptoms of internal bleeding, and when to seek help.
To make the switch, your prescriber will have you stop taking warfarin. Then, once your INR is less than 3 (less than 2.5 for children), you’ll start taking Xarelto. INR stands for international normalized ratio. It’s a blood test that measures how long it takes your blood to clot.
Other anticoagulants to Xarelto
You may need to switch from another blood thinner (other than warfarin) to Xarelto. To make this switch, you’ll stop your current blood thinner. Then you’ll start taking Xarelto in place of it when your next dose was originally due.
Xarelto to other anticoagulants
Switching from Xarelto to another blood thinner can also happen. If you’re making this switch, stop Xarelto and start the new anticoagulant when the next dose of Xarelto would have been due.
If you’re switching from Xarelto to warfarin, the process is a bit more complex. You may need to take more than one blood thinner while you’re waiting for warfarin to start working. Your prescriber will give you specific instructions to follow in this case.
6. Is Xarelto safe to take?
Yes, Xarelto is considered a safe medication for most people. But, like all medications, there are still side effects and risks to consider when you’re taking it.
Bleeding risk
Xarelto’s main risk is that it raises the chance of bleeding while you’re taking it. But in studies, Xarelto had a lower risk of serious and fatal bleeding than warfarin.
Your bleeding risk may be higher with Xarelto if you:
Have liver or kidney disease
Take other medications that make bleeding more likely, such as aspirin or certain antidepressants
Are age 65 or older
Let your healthcare team know if you notice signs of mild bleeding while taking Xarelto. These include nose bleeds, light bruising, or bleeding from the gums while brushing your teeth.
Signs of severe bleeding
You should seek call 911 or seek emergency medical attention right away if you notice signs of severe bleeding while taking Xarelto, such as:
Bleeding that doesn’t stop
Bruising that worsens or doesn’t go away
Blood in your urine
Blood in your stool (can be bright red or black, tarry stool)
Coughing up blood
Vomiting blood (may look like coffee grounds)
7. How can you save on Xarelto?
There are ways to save on Xarelto, which is available as both a brand-name and generic medication (in certain doses).
Save with GoodRx. GoodRx can help you save over 70% off the average retail price of the generic version. Generic Xarelto’s price at certain pharmacies is as low as $52.37 for the 2.5 mg tablets by using GoodRx.
Save with a copay savings card. If you have commercial insurance, you may be eligible to pay as little as $10 for a 30 or 90-day supply of brand-name Xarelto using a copay savings card from the manufacturer.
Save with patient assistance programs. If you’re uninsured or underinsured, you may be eligible for Xarelto’s patient assistance program, which offers the medication free of cost.
Other frequently asked questions
Yes, you can take bisoprolol (a beta blocker medication) with rivaroxaban if your prescriber recommends it. The two medications don’t interact, so it’s safe to combine them.
Xarelto side effects may include back pain and stomach pain, but chest pain isn’t common. In fact, chest pain can be a symptom of a heart attack or blood clot. So if you experience chest pain while taking Xarelto, it’s best to seek emergency medical care right away.
It’s recommended to take Xarelto with your evening meal if you’re taking it once daily for atrial fibrillation. This is because blood clots seem to be more likely to occur in the early morning hours. Taking Xarelto in the evening helps ensure it stays at an effective level in your system during this time.
Yes, you can take bisoprolol (a beta blocker medication) with rivaroxaban if your prescriber recommends it. The two medications don’t interact, so it’s safe to combine them.
Xarelto side effects may include back pain and stomach pain, but chest pain isn’t common. In fact, chest pain can be a symptom of a heart attack or blood clot. So if you experience chest pain while taking Xarelto, it’s best to seek emergency medical care right away.
It’s recommended to take Xarelto with your evening meal if you’re taking it once daily for atrial fibrillation. This is because blood clots seem to be more likely to occur in the early morning hours. Taking Xarelto in the evening helps ensure it stays at an effective level in your system during this time.
The bottom line
Xarelto (rivaroxaban) is a blood thinner used to treat and prevent unwanted blood clots. It starts working within 2 to 4 hours of your first dose. Xarelto stays in your system for 1 to 2 days once you stop taking it. So you’ll typically stop taking it at least 24 hours before a surgery or procedure that’s likely to cause bleeding.
You don’t need frequent blood tests or careful meal planning with Xarelto the way you do with warfarin. So Xarelto is a more convenient option for some people. How long you take Xarelto depends on the reason you’re taking it. Some people may only need to take it for a few weeks. For other people, Xarelto is a long-term medication.
The biggest risk of taking Xarelto is the chance of bleeding. So keep an eye out for signs and symptoms of bleeding and seek medical care if they occur.
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References
Brunner-Ziegler, S., et al. (2016). Comparison between the impact of morning and evening doses of rivaroxaban on the circadian endogenous coagulation rhythm in healthy subjects.
Centers for Disease Control and Prevention. (2024). Know the risks, signs & symptoms of blood clots infographic.
DrugBank. (2025). Rivaroxaban.
Mueck, W., et al. (2013). Clinical pharmacokinetic and pharmacodynamic profile of Rivaroxaban. Clinical Pharmacokinetics.
Patel, M. R., et al. (2011). Rivaroxaban versus Warfarin in nonvalvular atrial fibrillation. The New England Journal of Medicine.
Polania Gutierrez, J. J., et al. (2023). Perioperative anticoagulation management. StatPearls.
Singh, R., et al. (2023). Rivaroxaban. StatPearls.
