Rivaroxaban, sold under the brand name Xarelto among others, is an anticoagulant medication (blood thinner) used to treat and reduce the risk of blood clots. Specifically it is used to treat deep vein thrombosis and pulmonary emboli and prevent blood clots in atrial fibrillation and following hip or knee surgery. It is taken by mouth.

Common side effects include bleeding. Other serious side effects may include spinal hematoma and anaphylaxis. It is unclear if use in pregnancy and breastfeeding is safe. Compared to warfarin it has fewer interactions with other medications. It works by blocking the activity of the clotting protein factor Xa.

Rivaroxaban was patented in 2007 and approved for medical use in the United States in 2011. It is available as a generic medication. It is on the World Health Organization's List of Essential Medicines. In 2023, it was the 88th most commonly prescribed medication in the United States, with more than 7 million prescriptions.

Rivaroxaban is indicated to reduce risk of stroke and systemic embolism in nonvalvular atrial fibrillation; for the treatment of deep vein thrombosis; for the treatment of pulmonary embolism; for the reduction in the risk of recurrence of deep vein thrombosis or pulmonary embolism; for the prophylaxis of deep vein thrombosis, which may lead to pulmonary embolism in people undergoing knee or hip replacement surgery; for the prophylaxis of venous thromboembolism in acutely ill medical patients; to reduce the risk of major cardiovascular events in people with coronary artery disease; to reduce the risk of major thrombotic vascular events in people with peripheral artery disease, including people after recent lower extremity revascularization due to symptomatic peripheral artery disease; for the treatment of venous thromboembolism and reduction in the risk of recurrent venous thromboembolism in children from birth to less than 18 years of age; for thromboprophylaxis in children aged two years of age and older with congenital heart disease after the Fontan procedure.

In those with non-valvular atrial fibrillation, rivaroxaban appears to be as effective as warfarin in preventing strokes and embolic events in patients who are classified as moderate-to-high risk, as defined by a score of a number of specific medical conditions.

In July 2012, the UK's National Institute for Health and Clinical Excellence recommended rivaroxaban to prevent and treat venous thromboembolism.

When undergoing surgeries, due to the concern over managing bleeding, rivaroxaban can be discontinued 24 hours prior to low-bleeding risk surgery and 48-72 hours prior to high-bleeding risk surgeries. Once the surgery is over, it can be recommenced after 1 to 3 days with doctor consultation.

Dosing recommendations do not recommend administering rivaroxaban with drugs known to be strong combined CYP3A4/P-glycoprotein inhibitors because this results in significantly higher plasma concentrations of rivaroxaban. A small retrospective cohort study reported that the use of moderate CYP3A4 and P-glycoprotein inhibitors such as amiodarone or verapamil, increased the risk of bleeding when administered with rivaroxaban. Although this increase was not statistically significant, there was a trend showing increased bleeding in the rivaroxaban with moderate CYP3A4 and P-glycoprotein inhibitors group. Therefore, it is important to monitor for bleeding when concurrently on rivaroxaban and moderate CYP3A4 and P-glycoprotein inhibitors.