Rivaroxaban (Xarelto)

Raw research findings for this medication. Mostly single studies, not curated or confirmed robust.

About Rivaroxaban

What it is

Rivaroxaban is a direct oral anticoagulant (DOAC): it blocks factor Xa, a central clotting enzyme, so blood takes longer to clot. Unlike warfarin it does not need regular blood tests. It is used to lower the chance of stroke in atrial fibrillation, to prevent and treat clots in the legs and lungs, and after hip or knee replacement. It is sold as Xarelto.

How genes come into it

Rivaroxaban is broken down by CYP3A4 and CYP2J2 and pumped out of cells by ABCB1 and ABCG2; about a third is cleared unchanged by the kidneys. Studies have looked at ABCB1 and CYP3A5 variants for its blood levels and bleeding, with mixed results. Unlike warfarin, no gene has been found to change its effect much, and there is no CPIC or DPWG guideline.

What research found

Every published finding on gene variants and Rivaroxaban. Upload your DNA file to see which of these rows apply to you.

Rated evidence (4 rated variants)

PharmGKB weighs all studies of a variant and rates how strong the evidence is, from 1A (strongest) to 4.

ABCB1 rs1045642: Level 3. Metabolism/PK. 2.

ABCB1 rs1045642: Level 3. Metabolism/PK. 1.

ABCB1 rs2032582: Level 3. Metabolism/PK. 1.

ABCB1 rs1045642: Level 3. Toxicity. 1.

Metabolism (31 findings)

Studies of how quickly the body processes this medication.

ABCB1 rs1045642: Genotype GG is associated with decreased concentrations of apixaban, dabigatran, edoxaban or rivaroxaban in people with Thromboembolism as compared to genotypes AA + AG.

ABCB1 rs1045642: Genotypes AA + AG are associated with increased clearance of rivaroxaban in people with Atrial Fibrillation as compared to genotype GG.

ABCB1 rs1045642: Genotypes AG + GG is associated with decreased concentrations of rivaroxaban in people with Atrial Fibrillation as compared to genotype AA.

ABCB1 rs1128503: Genotype AA is associated with increased concentrations of rivaroxaban in people with Atrial Fibrillation as compared to genotypes AG + GG.

Side effects (5 findings)

Studies of side effects in people carrying a variant.

CYP3A5 rs776746: Genotype TT is associated with decreased concentrations of rivaroxaban in people with Venous thromboembolism as compared to genotypes CC + CT.

NCMAP rs4553122: Allele C is associated with increased response to rivaroxaban in people with Atrial Fibrillation as compared to allele T.

PRF1 rs885821: Allele G is associated with increased response to rivaroxaban in people with Atrial Fibrillation as compared to allele A.

PRKAG2 rs12703159: Allele C is associated with increased response to rivaroxaban in people with Atrial Fibrillation as compared to allele T.

Other findings (1 finding)

Studies that do not fall into the groups above.

BRD3 rs467387: Genotype AA is associated with increased response to rivaroxaban in healthy individuals as compared to genotypes AG + GG.

Study findings and evidence levels: PharmGKB (CC BY-SA 4.0). Guidelines: CPIC and DPWG, as bundled in PharmCAT. Most studies were done mainly in people of European ancestry.

Related Drugs

More drugs from the same category

Eliquis (DOACs)

Pradaxa (DOACs)

Savaysa (DOACs)

Not a prescribing recommendation. This page is educational information about pharmacogenomic research and clinical guidelines - it is not medical or dosing advice, and not a prediction of how any medication will work for you. Never start, stop, or change a medication or dose based on it; talk to your doctor or pharmacist, who can order clinical-grade testing if appropriate.

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Content updated September 2026.

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