Xarelto vs. Coumadin
See how Xarelto and Coumadin compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Xarelto is a newer blood thinner that does not require routine blood testing, while Coumadin has been used for over 60 years but needs regular INR monitoring.
Both drugs treat blood clots and atrial fibrillation, but only Coumadin is approved for people with mechanical heart valves.
Xarelto typically costs more per month than Coumadin, which is widely available as an inexpensive generic.
Xarelto vs. Coumadin Drug Summary
Xarelto
Xarelto (rivaroxaban) is a factor Xa inhibitor that thins the blood to help prevent strokes, blood clots, and pulmonary embolism. It comes as a tablet taken once or twice daily depending on the condition being treated. Unlike older blood thinners, it does not require routine blood testing.
Coumadin
Coumadin (warfarin) is a vitamin K antagonist that has been used to prevent and treat blood clots since the 1950s. It is taken as a once-daily tablet, with the dose adjusted based on regular INR blood tests. It is also the standard anticoagulant for people with mechanical heart valves.
Xarelto vs. Coumadin Side Effects
Xarelto
Coumadin
Xarelto vs. Coumadin Dosage
Xarelto
Coumadin
| STAGE | DOSE | WHEN |
| Starting dose | 10 mg once daily | At the start |
| Maximum dose | 20 mg once daily | Day 22 onward |
| Dose changes | 3 increases | Every 21 days |
| STAGE | DOSE | WHEN |
| Starting dose | 2 to 5 mg once daily | Days 1-5 |
| Maximum dose | 2 to 10 mg once daily | If needed |
| Dose changes | 1 increase | As tolerated |
Xarelto
| STAGE | DOSE | WHEN |
| Starting dose | 10 mg once daily | At the start |
| Maximum dose | 20 mg once daily | Day 22 onward |
| Dose changes | 3 increases | Every 21 days |
Coumadin
| STAGE | DOSE | WHEN |
| Starting dose | 2 to 5 mg once daily | Days 1-5 |
| Maximum dose | 2 to 10 mg once daily | If needed |
| Dose changes | 1 increase | As tolerated |
Xarelto vs. Coumadin Indications
Xarelto
Xarelto is FDA-approved to reduce stroke risk in atrial fibrillation, treat DVT and PE, and prevent their recurrence. It is also used to prevent blood clots after hip or knee replacement surgery and in certain hospitalized medical patients. It is not approved for people with mechanical heart valves.
Stroke prevention in atrial fibrillation
Treatment of DVT and PE
Prevention of DVT/PE recurrence
Prophylaxis after hip or knee replacement
Coumadin
Coumadin is FDA-approved to treat and prevent venous thrombosis, pulmonary embolism, and clot-related complications from atrial fibrillation. It is also the standard anticoagulant for people with mechanical heart valves and for reducing repeat events after a heart attack. It has been used for these purposes for decades.
Treatment of venous thrombosis and PE
Stroke prevention in atrial fibrillation
Prevention of clots with mechanical heart valves
Reduced risk of death or recurrent heart attack
Xarelto vs. Coumadin Pros and Cons
Xarelto
Xarelto offers predictable, fixed dosing without the need for routine blood monitoring, making it easier to fit into daily life. It costs more out of pocket than Coumadin and is not an option for people with mechanical heart valves.
Pros
No routine blood testing needed
Fewer food and drug interactions than warfarin
Simple fixed dosing without regular adjustments
Specific reversal agent (andexanet alfa) available
Cons
Not approved for mechanical heart valves
Roughly $440 to $650 per month without insurance, before savings programs
Reversal agent is newer and less widely stocked than vitamin K
Boxed warning for spinal or epidural bleeding with certain procedures
Coumadin
Coumadin has decades of real-world use and costs far less than Xarelto, but it demands regular INR checks and careful attention to diet and other medications. It remains the anticoagulant of choice for people with mechanical heart valves.
Pros
Approved for mechanical heart valves, unlike Xarelto
Roughly $40 to $100 per month without insurance
Decades of clinical experience across many populations
Antidote (vitamin K) is inexpensive and widely available
Cons
Requires regular INR blood test monitoring
Many food and drug interactions to manage
Narrow therapeutic index needs frequent dose changes
Genetic differences can affect dosing needs
Common Symptoms and Related Diseases You Can Explore
Explore a range of common symptoms the Doctronic Symptom Checker can help you understand.