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Xarelto is a brand name of rivaroxaban, a prescription blood-thinner medication.¹
Blood thinners are medicines that help prevent blood clots from forming or getting larger. Blood clots in your arteries and veins can cause blockages, heart attacks, and strokes. Blood thinners are commonly prescribed alongside other condition-specific medications, for example, if the patient suffers from certain heart or blood vessel conditions, or to reduce the risk of clots after surgery.
The Food and Drug Administration (FDA) approved Xarelto in 2011 to prevent clotting that could lead to stroke, particularly in people who suffer from atrial fibrillation. Xarelto was also approved as a complementary medication for the prevention of peripheral arterial disease and acute coronary syndrome.
As an anticoagulant, Xarelto targets specific proteins and enzymes that help your blood clot, also known as ‘clotting factors.’ Anticoagulant blood thinners keep these proteins and enzymes from doing their job, thereby reducing your blood's ability to clot.
Xarelto is in a group of alternative anticoagulants known as ‘direct oral anticoagulants’ (DOACs).² Unlike traditional blood thinners, DOACs target fewer of the proteins and enzymes that cause your blood to clot. Xarelto is an Xa inhibitor, a unique class of medication that targets only one clotting factor known as Factor Xa or 10a.
Depending on the condition it's used for, Xarelto can be prescribed for either short-term or long-term use. Unfortunately, while Xarelto doesn't require the same frequent blood tests as some other blood thinners, it may cause several side effects, ranging from mild to severe and even life-threatening.
In addition to the FDA-approved indications for use, Xarelto is also commonly prescribed to treat deep vein thrombosis (DVT), a blood clot that occurs in the leg, and pulmonary embolism (PE), a blood clot in the lung. The medication is also used to reduce the risk of DVT and PE recurring in adults who continue to be at risk.
Xarelto is also effective for reducing the risk of blood clots in people with decreased mobility and is used to help prevent blood clots from forming in the legs and lungs of patients who have undergone knee- or hip-replacement surgery. In addition, Xarelto is prescribed to patients that have been hospitalized and are at risk of getting blood clots.
As mentioned earlier, the medication can also reduce the risk of stroke or severe blood clots in adults with atrial fibrillation. This is a type of arrhythmia where the heart's atriums beat irregularly and are not in coordination with the ventricles, leading to issues with blood flow. The condition increases the risk of blood clots, which can travel through the body to the brain and cause a stroke.
Doctors may also prescribe Xarelto and a low dose of aspirin to reduce the risk of heart attack and stroke in people with coronary artery disease. Aspirin and Xarelto are sometimes used together to lower the risk of peripheral arterial disease, a condition that reduces blood circulation in the arms and legs.
The two drugs may also be prescribed together for adults who have recently had a procedure to improve blood flow in the arms or legs, such as angioplasty or stent placement.
Like many prescription medications, Xarelto can cause side effects that vary in severity. Most of the side effects of Xarelto usually reduce within a few days to a couple of weeks after beginning treatment. However, in some instances, side effects may linger or worsen, in which case you should talk with your doctor or pharmacist.
One of the more common side effects caused by Xarelto is muscle pain and spasms, especially in the lower back and extremities. About 3% of people who take Xarelto experience lower back pain.¹ The pain typically gets better within a few days, but in some cases, lower back pain while taking Xarelto can be a sign of a severe complication.
Xarelto is an anticoagulant that makes it harder for your blood to clot. While effectively stopping the formation of most blood clots, the medication won't stop all of them. It can also carry an increased risk of bleeding. For instance, when taking Xarelto, you may find that it takes longer for a small cut to stop bleeding and that you bruise more easily.
Xarelto doesn't only affect bleeding from cuts or scrapes. Xarelto's ability to prevent blood clotting also extends to your internal tissue, and the medication can cause bleeding anywhere in the body. For example, it's been reported that in less than 4% of cases, Xarelto can cause internal bleeding in the brain, spine, adrenals, retinas, and lungs, which may lead to severe complications or even death.¹
The amount of bleeding varies depending on several factors, including:
The dosage of Xarelto
Other drugs being taken
The condition being treated
In severe cases, a blood transfusion may be necessary, as well as medication to reverse the effects of Xarelto in your body.
Sometimes, internal bleeding from a damaged blood vessel causes the formation of a hematoma. This is an accumulation of clotted blood that forms when blood from a broken blood vessel begins to pool in the surrounding tissue. Hematomas can occur in organs such as the liver or the skin and muscles. While most hematomas are minor and go away on their own if under the skin or in a muscle, they can cause painful swelling.
Spinal epidural hematoma
Lower back pain could be a sign of spinal epidural hematoma, an accumulation of blood in the epidural space.³ The condition compresses the spinal cord, causing acute pain that could lead to paralysis. In addition to lower back pain, a spinal epidural hematoma can produce symptoms such as numbness, tingling or weakness in the limbs, and urinary incontinence.
People who undergo a spinal procedure while taking an anticoagulant like Xarelto have an increased risk of developing a spinal epidural hematoma. While rare, spinal or epidural blood hematomas can form rapidly and cause severe pain at the site locally while also radiating through the lower back and to the legs or arms.
Suppose you are taking Xarelto and have a spinal or epidural injection, for example, for anesthesia or a steroid injection. There is a higher risk that the injection will cause bleeding around your spine, leading to spinal epidural hematoma. When blood pools and forms a hematoma in your spine or brain, it can cause long-term or permanent damage that leads to pain, loss of mobility, and even paralysis.
A lumbar puncture or spinal tap while taking Xarelto also increases your risk of developing a spinal epidural hematoma.⁴ This risk is greater if you take other medications, including nonsteroidal anti-inflammatory drugs (NSAIDs). Your risk is also higher if you have a history of spinal issues or have had difficult or repeated epidural or spinal procedures or surgery on your spine.
A relatively common side effect of Xarelto is abdominal pain, affecting nearly 3% of clinical trial participants.⁵ However, severe abdominal pain can also be a symptom of internal bleeding. Since Xarelto is known to cause internal bleeding, you should consult your doctor if you experience abdominal pain while taking the medication. While mild abdominal pain is most likely not a sign of internal bleeding, an examination by your doctor can determine whether the issue is a severe side effect, and suggest treatments to relieve the condition.
While abdominal pain and lower back pain are two of the most common side effects of Xarelto, you should not ignore them. Even if the symptoms seem mild, you should consult your doctor. However, if the back pain is severe or accompanied by tingling, numbness, or muscle weakness, or your abdominal pain is severe or accompanied by nausea, dizziness, or vomiting, you should seek emergency medical services immediately.
It's important to talk with your doctor about your medical history before taking Xarelto. It is not the safest option for patients with certain medical conditions.
You shouldn't take Xarelto if you are allergic to rivaroxaban or any component of the drug's formula or if you have a history of bleeding problems. Additionally, Xarelto should not be taken by patients who have:
An artificial heart valve
Rheumatic heart disease⁶
Moderate to severe mitral stenosis⁷
Triple-positive antiphospholipid syndrome (APS)⁸
In some cases, Xarelto can lead to severe complications which require immediate medical attention. Call your doctor or seek medical help immediately if you develop any of these symptoms:
Abnormal bleeding such as nosebleeds, bleeding from the gums, vaginal bleeding, or menstrual bleeding that is heavier than normal
Severe bleeding that you can't control
Red, pink, or brown urine, which could indicate blood in your urine
Red or black tar-colored stools
Coughing up or spitting up blood or blood clots
Vomit that is coffee-colored or contains blood
Weakness in the extremities
Pain or swelling of wounds
Severe abdominal, stomach, or lower back pain
Urinary or fecal incontinence
Xarelto is an FDA-approved medication used to prevent blood clots caused by various conditions. The drug is a unique anticoagulant that reduces blood clots by targeting one specific clotting factor.
Xarelto is effective but may cause side effects. While most of the side effects of Xarelto are mild, in some cases, the medication can cause lower back pain and severe complications. Lower back pain could be an adverse effect that goes away in a few days or could be a sign of a much more dangerous side effect, such as hemorrhage or hematoma in your organs or spine.
Spinal epidural hematoma (2010)
Lumbar puncture (2021)
Rheumatic heart disease (2021)
Mitral stenosis (2021)