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What is an anticoagulant?
Blood-thinning medications are taken by over 2 million people a year in the United States. These medications are an essential part of treatment plans and often need to be taken daily. Blood thinners do not thin the blood but prevent the formation of blood clots in the bloodstream. There are two types of blood-thinning medications: anticoagulants and antiplatelets.
Antiplatelet drugs interfere with the binding of platelets. When this binding of platelets is prevented, then the risk of blood clots decreases. Anticoagulants work by interfering with the proteins (factors) in the blood that are involved with the coagulation process. One of the most popular anticoagulants on the market is Xarelto. Heparin and warfarin (Coumadin) are also commonly used.
Blood-thinning medications are used so prevalently because many conditions present the risk of blood clots. All of the following conditions can cause blood to pool in your vessels:
- Abnormal heartbeat
- Congenital heart defect
- Problems with blood circulation
- Heart disease
- A recent heart valve surgery
a. How does a blood clot form?
Blood clots are a necessary function of the body. When you get a cut or injury, blood clots stop excessive bleeding and form a scab over the wound. But if you have one of the above conditions, then blood clots can lead to serious medical problems. Clots form when tiny bits of your blood (platelets) are triggered by blood vessel damage and stick to the wall of the vessel. This creates a plug that fills in the broken part of the vessel.
In normal situations, the clot will not grow any bigger than it needs to. Problems begin to arise if you have cholesterol plaques in the arteries. When this plaque breaks open, the clotting process will begin. The majority of heart attacks and strokes occur when a plaque in your heart or brain bursts. Blood clots can also form if the blood is not flowing properly and pools in the vessels or heart, which can lead to atrial fibrillation and deep vein thrombosis. 
Blood clot symptoms
It is essential to learn the warning signs of blood clots so that you can seek medical help right away. If you get a clot in your arteries, it can keep oxygen from getting to vital organs like the lungs, heart, and brain. This can lead to a heart attack or stroke. You could also get a clot in the veins that carry blood back to the heart. This does not lead to immediate trouble, but the symptoms can come on gradually and lead to health problems down the road. Pay attention to the following signs if you are at risk for blood clots.
Arms and legs: Swelling, change in skin color (blue tinge), pain, trouble breathing, lower leg cramp
Heart: severe pain in your chest or arm, difficultly breathing, sweating
Lungs: shortness of breath, pain in the chest, sweating, dizziness
Brain: problems with vision or speech, seizure, feeling of weakness
Stomach: nausea or vomiting, diarrhea, bloody stools, bloated feeling, severe pain in the belly
Kidneys: blood in the urine, fever, nausea, high blood pressure, sudden severe leg swelling, pain in the side of the stomach, legs, or thighs 
History of Xarelto
Xarelto, also known by its main ingredient Rivaroxaban, was approved by the U.S. Food and Drug Administration in 2011. That year, Xarelto was approved for use in the prevention of stroke and for patients with atrial fibrillation (irregular heartbeat). As time went on, its usage was expanded to the prevention and treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE). Xarelto was hugely popular when it was released and made over $2 billion in sales by 2013. 
Xarelto belongs to a class of drugs known as Factor Xa inhibitors. These inhibitors act as an anticoagulant that blocks the activity of clotting factor Xa, which is a protein in the blood that stops bleeding. Through blocking Xa, Rivaroxaban keeps the clots from developing or getting worse. Many people prefer Xarelto to other blood thinners because it requires less frequent blood testing and dosage adjustments.
Side effects of Xarelto
Excessive bleeding is a risk with every blood-thinning medication. Several studies have found that bleeding risks with Xarelto are similar to other blood-thinning drugs. It is essential to tell your doctor if you are taking other blood thinners in combination with Xarelto because that interaction could increase your bleeding risk.
It is important to seek medical help if you experience the following while taking Xarelto:
- Red, brown, or pink urine
- Pain, swelling
- Vomit that looks like coffee grounds
- Uncontrollable bleeding
- Heavy menstrual or vaginal bleeding
- Frequent nose bleeds or bleeding gums
- Headaches or dizziness 
To prevent your risk of excessive bleeding, you should:
- Avoid contact sports and other activities that may cause injury.
- Be sure to wear an identification bracelet that describes your condition and risk for bleeding.
- Use a soft-bristled toothbrush.
- Tell your roommates, friends, and family that you are on blood-thinners, so they know you are at risk for excessive bleeding.
- Tell your doctor or dentist you are taking blood-thinners before a surgery or procedure. 
What to know before taking Xarelto
Xarelto generally has the same risks and side effects of every other blood-thinner medications, but it is vital to mention the few differences. It is vital to be transparent with your healthcare team and tell them about any conditions you have had in the past or any illnesses that are present in your family’s medical history. Let your doctor know if you have any bleeding problems, kidney issues, or antiphospholipid syndrome (APS) before taking Xarelto. APS is an autoimmune disorder that can include blood clots.
Xarelto can pose dangerous side effects if you have undergone procedures in your spinal area. People who take Xarelto and have had medicine injected into their spine may form a blood clot that can cause a loss of mobility (paralysis). Your risk of epidural clots is increased if you have a history of epidural or spinal punctures or have had surgery on your spine.
Price of Xarelto
Those who use Xarelto are pleased that they do not have to go in for as much testing and dosage adjustments, but the cost of Xarelto in the U.S. can be a hard pill to swallow. In the United States, a 30 day supply of Xarelto can cost close to $500. Many patients who need this drug turn to online Canadian pharmacies to get these drugs at a lower cost. If you use Canada Med Pharmacy, the cost of Xarelto is around $200 for a 30 day supply. Canada Med Pharmacy can be an excellent alternative for Americans that want their prescription medications at more affordable costs. 
a. Where is the generic version?
As of right now, there is no generic version of Xarelto. When a drug manufacturer makes a new medication, they retain the patent rights to the brand-name medication. This prevents any other manufacturer from creating a generic version of the drug. In the case of Xarelto, Bayer AG and Johnson & Johnson received a court ruling allowing them to retain the patent rights to Xarelto. The ruling upholds the patent until 2024, so a low-cost version of Xarelto will not be available for several years. In the meantime, check out Canada Med Pharmacy for discounted Xarelto and thousands of other prescription drugs. 
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