Key takeaways:
Atrial fibrillation (AFib) increases your risk of blood clots that can cause a stroke. Blood thinner medicines can help prevent these blood clots from forming.
Xarelto (rivaroxaban) has largely replaced warfarin as the preferred blood thinner for people with AFib. But each has its own benefits and risks.
Xarelto is usually more expensive than warfarin. But there are ways to save on Xarelto. A manufacturer savings card can help you get Xarelto for as little as $10 per prescription. A patient assistance program is also available.
If you need to take an anticoagulant (blood thinner) for atrial fibrillation (AFib), choosing the best option can be confusing. There are many factors to consider, including cost, side effects, and monitoring blood tests.
For a long time, warfarin (Coumadin, Jantoven) was the most popular option. But that’s no longer the case, now that there are newer medications like Xarelto (rivaroxaban).
Both are effective at preventing clots, and both have their advantages and disadvantages. So, which blood thinner medicine should you choose? We’ll help you decide.
Is Xarelto a blood thinner?
Xarelto is the brand name for rivaroxaban, a blood thinner that prevents blood clots. It works by blocking factor Xa — a special protein in the blood that plays an important role in the clotting process.
Xarelto is part of a newer class of medications called “direct-acting oral anticoagulants” (DOACs). The FDA first approved Xarelto in 2011. Warfarin has been around for much longer — the FDA first approved it in 1954.
Healthcare professionals typically prescribe Xarelto for:
Blood clots in the legs (deep vein thrombosis or DVT)
Blood clots in the lungs (pulmonary embolism)
People who are at increased risk of blood clots
Stroke prevention in people who have AFib
How do Xarelto and other new blood thinner medicines compare to warfarin?
Xarelto and other newer blood thinner medicines are now the preferred blood thinners for AFib. This is because research has shown that they are better at preventing stroke in people with AFib. But each medicine still has its own pluses and minuses.
Some of the important points of comparison are:
Time to start working: It can take several days for warfarin to reach the right level in the blood — measured by the level of INR (international normalized ratio). Xarelto, on the other hand, starts working within hours.
Monitoring: Even after warfarin reaches the right level, a lot of things can make that level go too high or too low. Because of the day-to-day change in the blood level, warfarin requires frequent blood testing to make sure that it’s at the right level. Xarelto doesn’t require any monitoring.
Interactions: Warfarin interacts with food and other medications, which can affect its levels. While DOACs also have possible drug interactions, they aren’t known to interact with foods.
Price: Xarelto is usually more expensive than warfarin.
Other medical conditions: Warfarin is still the preferred blood thinner for people with mitral valve stenosis, mechanical heart valves, or antiphospholipid syndrome.
Bleeding risk: Xarelto may have a lower risk of life-threatening bleeding, a possible complication of any blood thinner. This may be partly because warfarin is more challenging to keep at the right level in the blood.
Reversibility: If someone does develop life-threatening bleeding, there are medications that can help reverse the effects of either medication. The reversal medicine for Xarelto is often more expensive and can be harder to access in smaller hospitals.
Alternatives to Xarelto
It’s important to note that there are other DOACs that are similarly effective as Xarelto. These include:
All of the new blood thinner medicines have slightly different advantages and disadvantages. For example:
Eliquis may have a lower risk of major bleeding compared to Xarelto.
Eliquis and Savaysa are safer choices for people with chronic kidney disease.
Xarelto and Savaysa are taken once a day. Eliquis and Pradaxa are usually taken twice a day for AFib.
Blood thinners for atrial fibrillation: Xarelto and warfarin are not your only options. Read our full guide to the blood thinners approved for atrial fibrillation (AFib), and how to compare your options.
Blood thinner interactions: There are some medication interactions that can increase your risk for life-threatening bleeding if you take a blood thinner.
What triggers AFib? If you are recently diagnosed with AFib, learn more about common triggers to help prevent future episodes.
Your healthcare team will help you weigh the risks and benefits of each option based on your particular needs.
What are some side effects of Xarelto?
The side effects of Xarelto are similar to the side effects of any blood thinner medicine. The biggest one is that it increases the risk of bleeding. This includes anything from a bleeding cut in the skin to a life-threatening bleed in the brain after a bad fall.
This risk of bleeding increases even more if you take other medications, such as:
Aspirin
Clopidogrel (Plavix)
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) and naproxen (Aleve)
Some antidepressant medications, like selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs)
Any other blood thinning medication, such as heparin or warfarin
The risk of bleeding while taking Xarelto also increases in those with liver disease or heavy alcohol consumption.
Xarelto and warfarin can also increase the risk of blood clots if you suddenly stop taking it or miss doses. This is due to a rebound effect — the body makes extra clotting factors after you stop taking the medication.
How to save on Xarelto
Warfarin is widely available as a generic medication, which makes it more affordable than Xarelto. But there are ways to save on Xarelto, which is mainly available as a brand-name medication. GoodRx can help you navigate between patient assistance programs and copay savings cards to save money on your prescription.
Save with patient assistance programs: If you’re uninsured or underinsured, you may be eligible for Xarelto’s patient assistance program, which offers the medication free of cost.
Save with a copay savings card: If you have commercial insurance, you may be eligible to pay as little as $10 for a 90-day supply of Xarelto using a savings card from the manufacturer.
Frequently asked questions
Yes, Xarelto is considered a strong blood thinner. It’s an effective way to both treat and prevent blood clots. And research suggests it may be more effective than warfarin for preventing stroke in people with AFib. Anyone who takes Xarelto is at increased risk for bleeding, which can sometimes be serious and life-threatening.
You can keep taking Xarelto indefinitely. Many people with AFib take it their whole lives to help prevent stroke. But some people need to stop the medication, or change blood thinners as their health circumstances change. For example, people who are at increased risk of falls and head trauma may need to stop taking Xarelto. Or if people develop kidney disease as they age, other blood thinners may be a safer choice.
Eliquis and Xarelto are newer blood thinning medicines that can effectively prevent stroke in AFib. But one might be safer than the other for you, depending on your other medical conditions. Eliquis may have a lower risk of stomach bleeding compared to Xarelto. It’s also the safer blood thinner for people with kidney disease or liver disease.
Yes, Xarelto is considered a strong blood thinner. It’s an effective way to both treat and prevent blood clots. And research suggests it may be more effective than warfarin for preventing stroke in people with AFib. Anyone who takes Xarelto is at increased risk for bleeding, which can sometimes be serious and life-threatening.
You can keep taking Xarelto indefinitely. Many people with AFib take it their whole lives to help prevent stroke. But some people need to stop the medication, or change blood thinners as their health circumstances change. For example, people who are at increased risk of falls and head trauma may need to stop taking Xarelto. Or if people develop kidney disease as they age, other blood thinners may be a safer choice.
Eliquis and Xarelto are newer blood thinning medicines that can effectively prevent stroke in AFib. But one might be safer than the other for you, depending on your other medical conditions. Eliquis may have a lower risk of stomach bleeding compared to Xarelto. It’s also the safer blood thinner for people with kidney disease or liver disease.
The bottom line
If you have atrial fibrillation (AFib) and need to take a blood thinner, you have several options. Xarelto (rivaroxaban) is one of the newer blood thinner medicines and is preferred over warfarin (Coumadin, Jantoven) for preventing stroke in AFib. It also has simpler dosages, and it doesn’t need to be monitored with blood tests. But warfarin might be a better choice if you have other conditions like heart valve disease. And it’s usually more affordable, too. The good news is that you don’t have to make this decision alone. Your healthcare team will help you figure out the best choice for you.
Why trust our experts?
References
American Academy of Family Physicians. (2020). Management of atrial fibrillation: Updated guidance from the AHA, ACC, and HRS. American Family Physician.
Catterall, F., et al. (2020). Warfarin in patients with mechanical heart valves. The BMJ.
Frydrych, M., et al. (2024). Prothrombotic rebound after discontinuation of direct oral anticoagulants therapy: A systematic review. Journal of Clinical Medicine.
Genetic and Rare Diseases. (2025). Antiphospholipid syndrome. National Center for Advancing Translational Sciences.
Guo, W., et al. (2019). Differences in gastrointestinal safety profiles among novel oral anticoagulants: Evidence from a network meta-analysis. Clinical Epidemiology.
Ingason, A. B., et al. (2023). Comparison of the effectiveness and safety of direct oral anticoagulants: A nationwide propensity score-weighted study. Blood Advances.
Janssen Pharmaceuticals. (2025). Xarelto-rivaroxaban [package insert]. DailyMed.
Kim, I., et al. (2018). Appropriate doses of non-vitamin K antagonist oral anticoagulants in high-risk subgroups with atrial fibrillation: Systematic review and meta-analysis. Journal of Cardiology.
Kirchhof, P., et al. (2020). Impact of modifiable bleeding risk factors on major bleeding in patients with atrial fibrillation anticoagulated with rivaroxaban. Journal of the American Heart Association.
Patel, M. R., et al. (2011). Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. The New England Journal of Medicine.
Rhee, T., et al. (2022). Efficacy and safety of oral anticoagulants for atrial fibrillation patients with chronic kidney disease: A systematic review and meta-analysis. Frontiers in Cardiovascular Medicine.
