Xarelto vs Warfarin: Which Is The Better Anticoagulant?

Authored by The Rx Advocates, / Medically Reviewed by Dr. Conor Sheehy, PharmD, BCPS
Last Updated: October 5, 2021

Xarelto and Warfarin are two of the most common medications used to prevent and treat blood clots in patients with a history of Deep Vein Thrombosis (DVT), Pulmonary Embolism (PE), and atrial fibrillation.

Both medications have been proven to be effective in reducing clots, but there are differences between them. Your doctor may choose one over the other based on the side effects, benefits, and risks these medications may pose to their patients.

 

What is Xarelto? 

Xarelto is an anticoagulant medication that was FDA approved in July 2011.  The generic name for Xarelto is rivaroxaban.

It is a medication commonly prescribed to treat a variety of blood clotting conditions such as Deep Vein Thrombosis (DVT) or Pulmonary Embolism (PE)  and prevent clotting in patients who have atrial fibrillation.  The medication works to block the production of certain clotting substances within the patient’s blood.  

. It may also be prescribed to prevent blood clots for acutely ill patients in the hospital who are at risk of blood clots but do not have a bleeding disorder.

Xarelto is a tablet that comes in various dosing amounts ranging from 2.5 mg – 20 mg tablets. Doctors will prescribe the appropriate strength based on their patients’ medical necessity and medical history.

 

The Side Effects of Xarelto

It is important to know the side effects of the medication you are prescribed.  Some side effects could require immediate medical attention. Side effects should be reported to a doctor, especially when starting a new medication.

Some side effects with Xarelto could be the following:

  • Heavy menstrual flow
  • Coughing up blood
  • Increased risk of minor or major bleeding

 

What is Warfarin?

Warfarin was FDA approved for usage in 1954 under the brand names of Coumadin and Jantoven. Warfarin is the generic name for the brand names.

Warfarin is an anticoagulant drug used to prevent or treat blood clots in veins and arteries.

It is important that Warfarin be taken at the same time every day and can be taken with or without food.

Using Warfarin requires frequent blood testing to measure the clotting or the prothrombin time test (INR). Certain foods may cause changes in the effectiveness of the drug while a patient is taking warfarin.

Cranberry juice, pomegranate juice, and grapefruit juice may cause drug interactions and should be avoided. Foods that are high in Vitamin K, should be consumed in as consistent of an amount as possible. Pain-relieving medicines such as ibuprofen, or naproxen should not be taken along with warfarin unless directed by your doctor.

 

Side Effects of Warfarin:

If a patient has any history of allergies when taking this medication, such as hives, swelling, or difficulty breathing, they should consult their doctor. This medication may not be suitable, and the patient’s doctor will find another.

Warfarin may not be appropriate to take for those patients that have very high blood pressure, have recently had or will have surgery on the brain, spine, or eye, or those who need to have a spinal tap or epidural.

Other side effects of Warfarin could include:

  • Swelling pain or unusual bruising.
  • Coughing up blood or vomit that looks like coffee grounds.
  • Bleeding gums, nosebleeds.
  • Bleeding that will not stop.
  • Sudden or severe leg or foot pain, purple toes or fingers.

Side effects should be reported to the patient’s doctor immediately.

 

Xarelto Vs Warfarin: Which Medication Works Best? 

Every patient has their own unique medical history. While both of these medications are anticoagulants that have been safety tested and proven effective, they still have pros and cons. A patient’s individual needs and outcomes need to be weighed by a doctor before determining which medication to prescribe.

 

What are the Pros and Cons of Xarelto? 

The pros of taking Xarelto to treat or prevent blood clots are:

  • No need for prothrombin time (INR) testing 
  • No regular dosage adjustments
  • No known dietary restrictions

The cons of taking Xarelto to treat or prevent blood clots are:

  • Higher cost for the medication as there is no generic equivalent
  • It cannot be used by people with valvular disease, including prosthetic heart valves

The main benefit of taking Warfarin for treating clotting issues is that it is inexpensive and has been proven effective at treating clotting issues for several decades.

The cons of taking Warfarin for treating clotting issues are:

  • Interactions with many foods.
  • Prothrombin Time testing (INR) is necessary to monitor medication levels in the blood.
  • Must avoid any herbal products such as St John’s Wort.
  • Higher incidence of major bleeding events in some patients.

As with any medication, a doctor will need to weigh which medication is best for the patient based on the risk versus the benefits for each individual.

 

The Rx Advocates Can Help People Save Money on Their Monthly Xarelto Prescriptions

Many doctors prefer to prescribe Xarelto to their patients due to its benefits over Warfarin. Patients prefer the ease of Xarelto and the lack of need for periodic blood testing (INR).

While Xarelto has many benefits that Warfarin does not, it does come at a higher prescription cost.  If your doctor recommends either prescription medication, Warfarin may seem like the obvious choice due to its lower expensive and proven track record.

At The Rx Advocates, we specialize in helping to make our patients’ monthly prescription medications more affordable. We work with patient assistance programs to get discounts for our patients. The patient only pays for our services.  Their medications are delivered to them at no additional cost.

We have helped people save hundreds of dollars every month on Xarelto as well as other anticoagulant medications. If paying for medication has been a concern for you, we can help. Please contact us today.

 

Sources: 

Xarelto https://www.xarelto-us.com

Warfarin https://www.drugs.com/warfarin.html

Xarelto https://www.drugs.com/xarelto.html

Advantages and Disadvantages of Novel Oral Anticoagulants https://www.dicardiology.com/article/advantages-and-disadvantages-novel-oral-anticoagulants

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