Table of Contents

I. The Two Types of Blood Thinners

II. Xarelto Overview

III. Benefits and Risks of Xarelto

IV. Coumadin

V. Eliquis

VI. Aspirin

VII. So, What's the Consensus?

VIII. FAQ: What Should I Ask My Doctor Before Choosing or Switching Blood Thinners?

Blood thinners such as Xarelto (rivaroxaban) help prevent harmful blood clots in people with conditions like atrial fibrillation, deep vein thrombosis, or pulmonary embolism. [1] Different blood thinners work in different ways, so read on to learn how the most commonly prescribed options compare.

The Two Types of Blood Thinners

There are two main types of blood thinners: anticoagulants and antiplatelets. Both help reduce the risk of harmful blood clots, but they work in different ways.

• Anticoagulants: These medications slow down the body’s clotting process. They can help prevent new clots from forming and keep existing clots from growing larger. Common anticoagulants include Xarelto, Eliquis, heparin, and warfarin.
• Antiplatelets: These medications prevent platelets from sticking together and forming a clot. They are commonly prescribed to people who have had, or are at risk of, a heart attack or stroke. Examples include aspirin and clopidogrel. [2]

Xarelto Overview

Xarelto (rivaroxaban) is an anticoagulant used to treat and prevent several types of blood clots. It is a factor Xa inhibitor that reduces the body’s ability to form clots. Xarelto may be prescribed to treat deep vein thrombosis (DVT), which usually forms in a deep vein in the leg, and pulmonary embolism (PE), which occurs when part of a clot travels to the lungs. It can also help prevent DVT and PE after hip or knee replacement surgery, when reduced mobility may increase the risk of clotting. [1]

Xarelto is also used to reduce the risk of stroke and blood clots in adults with nonvalvular atrial fibrillation. In some patients with coronary artery disease or peripheral artery disease, a lower dose of Xarelto may be prescribed with aspirin to reduce the risk of serious cardiovascular events. Xarelto received its initial U.S. approval in 2011. [1]

Benefits and Risks of Xarelto 

One advantage of Xarelto is that it does not require the same frequent clotting tests used with warfarin. However, your doctor may still check your kidney and liver function and review your overall health to make sure the medication remains appropriate. Xarelto leaves the body relatively quickly, so missing doses or stopping treatment without medical guidance can increase the risk of blood clots. [3]

The most common side effect of Xarelto is bleeding. Xarelto may also increase the risk of a spinal or epidural hematoma in people who receive spinal anesthesia or undergo a spinal puncture. This complication can cause long-term or permanent paralysis, so patients should tell their healthcare provider that they take Xarelto before any spinal procedure. [1]

Coumadin 

Coumadin, also known by its generic name warfarin, is an anticoagulant that slows the formation of blood clots. It works by reducing the production of vitamin K-dependent clotting factors in the liver. [4]

Benefits and Risks of Coumadin

Unlike Xarelto and Eliquis, warfarin requires regular blood testing to make sure the dose is producing the desired anticoagulant effect. Because the appropriate dose can be affected by factors such as age, diet, other medications, and health conditions, the dose may need to be adjusted over time. [4]

Warfarin also stays in the body longer than Xarelto or Eliquis, so missing a dose may not have the same immediate effect as missing a dose of one of these newer blood thinners. However, patients should still take warfarin exactly as prescribed. Warfarin can interact with foods and medications, particularly foods that contain vitamin K, such as spinach, kale, and chard. Warfarin is generally less expensive than newer blood thinners, although the cost of regular blood testing should also be considered. [3]

Eliquis 

Eliquis (apixaban) has several similarities to Xarelto. Both are anticoagulants that slow the formation of blood clots and may be used to reduce the risk of stroke and systemic embolism in people with atrial fibrillation. They are also used to treat and prevent deep vein thrombosis and pulmonary embolism. Eliquis may also be prescribed to prevent deep vein thrombosis after hip or knee replacement surgery. [5]

Benefits and Risks of Eliquis

Eliquis does not require frequent blood tests, although periodic kidney function checks may still be needed. [3] Its most common adverse reactions are related to bleeding. Other reported side effects include nausea, anemia, fainting, skin rash, and serious allergic reactions. [5]

Eliquis may interact with medications that increase bleeding risk, including aspirin, other antiplatelet drugs, heparin, other anticoagulants, NSAIDs, and certain antidepressants. Some strong antifungal and HIV medications may also raise apixaban levels in the body, while certain other drugs may lower its levels and make it less effective. Patients should give their doctor and pharmacist a complete list of everything they take before starting Eliquis. [5]

Because Eliquis works quickly and also leaves the body quickly, missing a dose may increase the risk of serious complications. [3] If a dose is missed, it should be taken as soon as possible that day, and the regular schedule should then continue. Patients should not take two doses at once to make up for a missed dose. [5]

Aspirin

Aspirin is a salicylate medicine used to reduce fever and relieve mild to moderate pain, inflammation, and swelling. It works by blocking natural substances in the body that contribute to fever, pain, swelling, and blood clot formation. [6] Aspirin may be used for short-term relief of headaches, migraines, period pain, general aches and pains, and symptoms associated with colds and flu. [7]

Benefits and Risks of Aspirin

Long-term treatment with low-dose aspirin has an antiplatelet effect, which makes the blood less sticky and helps prevent blood clots from forming. [7] A doctor may recommend daily aspirin to reduce the risk of a heart attack or stroke, particularly for people who have had a heart attack, angina, stroke, transient ischemic attack, peripheral arterial disease, or certain procedures involving the heart or blood vessels. [6]

Aspirin is not appropriate for everyone and should not be started as a daily treatment without medical advice. Speak with a doctor or pharmacist first if you are over 65 or have a history of stomach ulcers, bleeding disorders, severe kidney or liver problems, asthma, uncontrolled high blood pressure, or an allergy to aspirin or other NSAIDs. Aspirin can make bleeding and bruising occur more easily, so the possible benefits must be weighed against its risks. [7]

So, What’s the Consensus?

Every medication has benefits and drawbacks, and the best option depends on factors such as a person’s health conditions, genetics, lifestyle, and budget. Cost is an important consideration for many Americans. Some patients may be willing to pay more for Xarelto or Eliquis because these medications do not require frequent blood testing. Others may find that a lower-cost option, such as aspirin or Coumadin, is more suitable for their needs.

FAQ: What Should I Ask My Doctor Before Choosing or Switching Blood Thinners?

Before choosing or switching blood thinners, ask your doctor which option best fits your medical condition, health history, other medications, dosing schedule, monitoring needs, and budget. You should also ask what to do if you miss a dose, how often you need follow-up appointments, and whether any foods, supplements, or medications could interfere with treatment.

Xarelto and Eliquis usually do not require the same routine clotting tests as warfarin, but missed doses may raise the risk of complications because these medications leave the body relatively quickly. Warfarin may be less expensive, but it requires regular blood tests and caution with vitamin K. Aspirin should only be taken daily when recommended by a doctor.

Before choosing or switching blood thinners, ask your doctor:

1. Which blood thinner is approved for my condition?
2. What bleeding risks should I watch for?
3. How often do I need to take each dose?
4. What should I do if I miss a dose?
5. Will I need regular blood tests or kidney and liver checks?
6. Do I need to avoid or stay consistent with certain foods?
7. How do the costs compare, including blood testing, insurance coverage, and pharmacy options?

The content in this article is intended for informational purposes only. This website does not provide medical advice. In all circumstances, you should always seek the advice of your physician and/or other qualified health professionals(s) for drug, medical condition, or treatment advice. The content provided on this website is not a substitute for professional medical advice, diagnosis, or treatment.