Rivaroxaban: Mechanism of Action & Pharmacokinetics

Instructor: Alyssa Campbell

Alyssa is an active RN and teaches Nursing and Leadership university courses. She also has a Doctorate in Nursing Practice and a Master's in Business Administration.

Rivaroxaban is a powerful drug that can prevent life-threatening blood clots from forming. Read this lesson to learn how the drug takes action and how it is processed by the human body.

A New Medication

Lisa, a nurse on a medical-surgical floor, cares for patients with many different conditions. Everyone looks up to Lisa because of her vast experience, willingness to learn new treatments, and friendliness toward others. She eagerly awaits her early retirement but is still enjoying her last year in a full time job.

As she supervises a new nurse administering medications, Lisa notices a drug called rivaroxaban. Because the pair of nurses are unfamiliar with the new drug, they look rivaroxaban up in a formulary or medication guide to learn more about it before giving it to their patient.

What is Rivaroxaban?

Lisa learns that rivaroxaban is a blood thinning medication that can dissolve or prevent the development of blood clots. Prescribed by physicians and other health care providers, it is used to manage the following conditions:

  • Deep Vein Thrombosis: blood clots in the arms or legs
  • Pulmonary Embolism: type of blood clot that develops in the lungs

In an effort to prevent issues caused by blood clots, they learn that rivaroxaban is also prescribed to prevent the formation of clots. Risk factors indicating use for rivaroxaban include:

  • Atrial fibrillation: irregular heart beat allowing blood to stagnate or pool inside the heart, allowing it to clot
  • Smoking
  • Obesity
  • Recent surgery
  • History of clots

Understanding what the medication is used for, Lisa explains that the patient is prescribed the rivaroxaban due to a new diagnosis of atrial fibrillation to reduce his risk of clot formation. The pair dig further for more information regarding how it works.

Mechanism of Action

Lisa and the new nurse search for rivaroxaban's mechanism of action or process explaining how the drug works inside the body. First, they review the process of how blood clots in the body.

How Does Blood Clot?

Blood is made of several important components, including oxygen-carrying red blood cells, infection-fighting white blood cells, liquid plasma, and platelets. Platelets are a type of blood cell that gather together to form clots within our blood vessels. In healthy people with normal body functioning, injury would activate blood to the site of damage bringing oxygen, infection fighters, and platelets to stop any bleeding.

A platelet will begin to coagulate or form a clot with other platelets after it receives messages via little receivers on the surface of the cell. The process of blood coagulation is known as the clotting cascade, a series of chemical reactions that take place in order for the blood to actively clot. Rivaroxaban prevents clotting by blocking one of many important chemical reactions in the clotting cascade. This block prevents the production of fibrin making it impossible for the platelets to stick together and clot.


Like most medications, Lisa is aware that rivaroxaban may have an impact on the body and some of its organs. Together, the nurses investigate the pharmacokinetics to learn how the drug is processed and metabolized by the body.

When rivaroxaban enters the body through the mouth and is digested, it takes about 2-4 hours to reach effectiveness. After remaining effective in the body for anywhere between 10 to 26 hours, it is excreted and leaves the body through urine.

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