Xarelto vs Warfarin
XareltoWarfarin
Direct Factor Xa Inhibitor (DOAC)
Drug Class
Vitamin K Antagonist- Stroke prevention in atrial fibrillation (AFib) - Deep vein thrombosis (DVT) and pulmonary embolism (PE) treatment & prevention - Post-surgical DVT prevention
Primary Indications
- Stroke prevention in atrial fibrillation (AFib) - DVT and PE treatment & prevention - Heart valve replacement (mechanical valves)Directly inhibits Factor Xa, preventing thrombin formation and clotting
Mechanism of Action
Inhibits vitamin K-dependent clotting factors (II, VII, IX, X), reducing blood clottingOral tablets
Dosage Forms
Oral tablets- DVT/PE: 15 mg twice daily for 21 days, then 20 mg once daily - AFib: 20 mg once daily with food
Common Dosages
- Typically 2–10 mg once daily (dosing individualized based on INR)2–4 hours
Onset of Action
24–72 hours~24 hours
Duration of Action
Varies (dependent on INR levels)5–9 hours (healthy individuals) 11–13 hours (elderly)
Half-Life
20–60 hoursNo routine blood monitoring required
Monitoring Requirements
Requires regular INR blood monitoringNo major dietary restrictions
Dietary Restrictions
Avoid foods high in vitamin K (e.g., leafy greens) as they affect INR levels- Bleeding - Nausea - Dizziness - Fatigue
Common Side Effects
- Bleeding - Bruising - Hair loss - Nausea- Major bleeding (GI, intracranial) - Spinal hematoma (if combined with spinal procedures)
Serious Side Effects
- Severe bleeding - Skin necrosis - Purple toe syndromeAndexanet alfa (Andexxa) (Expensive, limited availability)
Reversal Agent
Vitamin K, Fresh Frozen Plasma (FFP), Prothrombin Complex Concentrates (PCCs)Category C (Risk not ruled out)
Pregnancy Category
Category X (Contraindicated in pregnancy)- CYP3A4 and P-gp inhibitors (ketoconazole, ritonavir) increase bleeding risk - NSAIDs and antiplatelets increase bleeding risk
Drug Interactions
- Many drug interactions (antibiotics, antifungals, NSAIDs, alcohol, thyroid medications, etc.)- Signs of bleeding - Kidney function (renal clearance affects dosage)
Monitoring Parameters
- INR (2.0–3.0 for most indications, 2.5–3.5 for mechanical valves)Expensive, brand-name only
Cost and Availability
Affordable, available as generic- No routine monitoring needed - Not recommended in severe kidney disease
Special Considerations
- Requires frequent INR monitoring - Affected by diet and many drug interactionsCoupon code
CMP30
Coupon code
Coupon code
CMP30
