Rivaroxaban is a substrate of CYP3A4, P-gp, and BCRP. Coadministration may increase rivaroxaban concentrations due to inhibition of P-gp and BCRP by velpatasvir. A large, retrospective, multi-centre cohort study of patients coadministered HCV DAAs and DOACs, including sofosbuvir/velpatasvir and rivaroxaban, reported a low incidence of bleeding which was similar to historic controls of patients with liver disease on DOACs alone, providing reassurance that any increase in rivaroxaban levels is unlikely to be clinically relevant in the majority of patients. However, caution may be required if coadministration occurs in patients with moderate to severe renal impairment. Patients should be reminded to promptly report any signs of bleeding or bruising as with anyone who is prescribed DOACs. [Note: product labels state that rivaroxaban is contraindicated in patients with hepatic disease associated with coagulopathy and clinically relevant bleeding risk, including cirrhotic patients with Child Pugh B and C.]