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Brand names: Xarelto • Drug class: Direct oral anticoagulant (Factor Xa inhibitor)
Rivaroxaban is a once-daily NOAC. In kidney disease, dosing depends on CrCl: 20 mg daily above CrCl 50, 15 mg daily at CrCl 15-49, and it should be avoided below CrCl 15. Rivaroxaban also protects against atherosclerotic events in CKD (COMPASS trial).
Rivaroxaban is ~35% renally cleared — more than apixaban. This is why the label restricts use: avoid below CrCl 15. For AF, the CrCl 15-49 dose is 15 mg once daily with food. It was also studied in the COMPASS trial for vascular disease, which included CKD patients.
15 mg daily for CrCl 15-49 (AF); avoid <15
FDA Xarelto prescribing information, 2024
COMPASS: rivaroxaban 2.5 mg BID + aspirin reduced major vascular events in stable vascular disease, including in CKD
COMPASS trial (Eikelboom JW et al., NEJM 2017), 2017
Once-daily dosing improves adherence vs twice-daily NOACs
Real-world adherence data, 2022
AF: 20 mg once daily (CrCl >50); 15 mg once daily (CrCl 15-49). VTE treatment: 15 mg BID ×21 days then 20 mg daily (CrCl ≥30); avoid in severe impairment. Always take the AF dose with food — absorption depends on it.
Check your kidney functionThis page is educational. Medication decisions — especially dosing changes — must be made by your prescribing clinician.
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This content is a general reference, not medical advice, a diagnosis, or a treatment plan. Do not change your diet, fluids, medicines, or dialysis plan without your nephrologist or renal dietitian. Individual recommendations depend on your labs, medications, conditions, and care plan.