Objective: To investigate the efficacy of different doses of rivaroxaban in the treatment of elderly patients with non-valvular atrial fibrillation (NVAF), and the impact on liver and kidney function. Methods: A total of 60 elderly patients with NVAF admitted to the hospital from January 2021 to January 2025 were selected as the research objects. Using random number table method, they were divided into the low-dose group (n=30) and the high-dose group (n=30). The low-dose group was treated with 10 mg of rivaroxaban by oral administration once a day, while the high-dose group was treated with 15 mg of rivaroxaban by oral administration once a day. The changes in National Institutes of Health Stroke Scale (NIHSS) scores, coagulation function [prothrombin time (PT), activated partial thromboplastin time (APTT)], and liver and kidney function indicators [alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum creatinine (Scr), blood urea nitrogen (BUN)] before and after treatment were compared between the two groups. Results: After treatment, both groups showed a decrease in NIHSS scores, and the high-dose group got a lower score (P<0.05). After treatment, both groups showed significant prolongation of PT and APTT (P<0.05). Meanwhile, the high-dose group had longer PT and APTT than the low-dose group (P<0.05). After treatment, the levels of ALT, AST, Scr, and BUN in both groups increased (P<0.05), but the increase was greater in the high-dose group (P<0.05). Conclusion: When rivaroxaban is used to treat elderly patients with NVAF, high dose (15 mg/d) is more effective in anticoagulation and improving neurological function. However, low dose (10 mg/d) have less influence on liver and kidney function and is safer. Clinically, the dose should be selected based on the patient’s condition.