Is Xarelto the Best Blood Thinner for Atrial Fibrillation?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
Posted on

Doctors treating patients with atrial fibrillation have embraced the new oral anticoagulants and more than 60% of new prescriptions are now written for the newer choices instead of warfarin (Coumadin). Xarelto seems to be gaining speed as the dominating new blood thinner. Xarelto use has increased quickly, with more patients being treated with this drug than with warfarin or Pradaxa in 2013.

Here are 10 things you need to know about Xarelto:

1.  There are four new players: rivaroxaban (Xarelto), apixaban (Eliquis), edoxaban (Lixiana) and dabigatran (Pradaxa).

2.  Compared to warfarin, Xarelto results in less major bleeding or brain hemorrhage but slightly more gastrointestinal bleeding. Generally, all of the newer anticoagulants are considered safer than warfarin because of this smaller risk of bleeding into the brain.

3.  In addition to being slightly safer than warfarin, Xarelto is more convenient: you don’t have to have blood tests to check your levels, you don’t have dietary restrictions, and there are fewer drug-to-drug interactions.

4.  Xarelto and Lixiana are taken only once a day, while Eliquis and Pradaxa are taken twice a day. That’s a plus for Xarelto.

5.  The risk of stroke if you have atrial fibrillation is lower on Xarelto than warfarin. That’s a huge plus.

6.  Sticker shock. On average, Xarelto costs patients 221 dollars for 6 months of medication. Find out your co-pay or cash price before you fill your prescription, there is no question warfarin will be cheaper.

7.  Switching from warfarin to Xarelto has been specifically studied. The recommendation is to start Xarelto when the INR is < 3.0 and you’ve stopped your warfarin.

8.  Unlike with warfarin, there is no way to reverse the blood thinning effects of Xarelto. The upside to that is that Xarelto has a short half-life so if it’s discontinued, normal anticoagulation returns in a relatively short time compared to warfarin.

9.  Lower doses of Xarelto can be used in elderly patients and those folks also taking aspirin or clopidogrel (Plavix).

10.  There are no head to head comparisons of the 4 new blood thinners so anyone who tells you Xarelto is “better” than the others doesn’t really know that to be true. Yet.

Dr O.

Drugs featured in this story

Filed under