Which statement best describes rivaroxaban in the context of long-term treatment of AF or VTE in older adults?

• A. Dabigatran is always preferred over rivaroxaban
• B. Rivaroxaban should be avoided for long-term treatment in older adults in favor of safer alternatives
• C. Apixaban is never used in older adults
• D. Edoxaban is always more risky than rivaroxaban

Answer: (B)

In older adults, safety is the top priority when choosing long-term anticoagulation for AF or VTE. Rivaroxaban has a bleeding risk profile that can be less favorable in seniors, particularly with respect to major and GI bleeding, compared with some other direct oral anticoagulants. Because there are alternative DOACs that offer similar stroke/PE prevention with better bleeding safety in many elderly patients, the guidance is to avoid rivaroxaban for long-term use in this population when safer options are suitable. This reflects a cautious, patient-centered approach to minimize harm while still protecting against thromboembolism.

Keep in mind this doesn’t mean rivaroxaban is never appropriate for any older patient—dose, renal function, and individual bleeding risk all matter. The other choices imply absolute statements about rivaroxaban’s use or about alternatives that the Beers criteria does not endorse universally, which is not the intended guidance.