Xarelto vs. Lovenox

See how Xarelto and Lovenox compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Xarelto is a once-daily oral tablet, while Lovenox is a subcutaneous injection dosed once or twice daily based on body weight.

  • Xarelto is FDA-approved to prevent stroke in atrial fibrillation, a use Lovenox does not have.

  • Lovenox is FDA-approved for heart attack-related care like unstable angina and STEMI, which Xarelto is not approved to treat.

Xarelto vs. Lovenox Drug Summary

Xarelto

Xarelto (rivaroxaban) is an oral factor Xa inhibitor used to prevent stroke in people with atrial fibrillation and to treat or prevent blood clots such as DVT and PE. It comes as a tablet, usually taken once a day, though the schedule varies by indication.

Lovenox

Lovenox (enoxaparin) is an injectable low molecular weight heparin used to prevent and treat blood clots and to manage certain heart attack conditions. It's given as a subcutaneous injection, dosed once or twice daily based on body weight and indication.

Xarelto vs. Lovenox Side Effects

Xarelto

Most common
Major bleeding (3.6%/year)
Pruritus (1% to 10%)
Rash (1% to 10%)
Back pain (common)

Lovenox

Most common
Anemia (up to 16%)
Hemorrhage (up to 13%)
Fever (up to 8%)
Peripheral edema (up to 6%)

Xarelto vs. Lovenox Dosage

Xarelto

Dosage
Dosage Table
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

Lovenox

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 1 mg/kg twice daily At the start
Maximum dose 40 mg once daily If needed
Dose changes 3 increases As tolerated

Xarelto vs. Lovenox Indications

Xarelto

Xarelto is FDA-approved to lower stroke risk in nonvalvular atrial fibrillation and to treat and prevent DVT and PE. It's also used to prevent blood clots after hip or knee replacement surgery and in certain hospitalized medical patients.

  • Stroke prevention in atrial fibrillation

  • Treatment of DVT and PE

  • Prevention of DVT/PE recurrence

  • Prophylaxis after hip or knee replacement

Lovenox

Lovenox is FDA-approved to prevent DVT after hip or knee replacement, abdominal surgery, or in medically ill patients with limited mobility. It's also used to treat DVT and PE alongside warfarin and to manage unstable angina and certain heart attacks.

  • DVT prophylaxis after orthopedic or abdominal surgery

  • Treatment of DVT/PE with warfarin

  • Unstable angina and NSTEMI management

  • STEMI treatment

Xarelto vs. Lovenox Pros and Cons

Xarelto

Xarelto's oral dosing and lack of routine blood monitoring make it practical for long-term, at-home use. It carries boxed warnings about stopping it early and about spinal procedures, and it isn't approved for heart attack-related care.

Pros

  • Oral tablet, no injections needed

  • Once-daily dosing for most indications

  • Only one of these two approved for atrial fibrillation stroke prevention

  • Specific reversal agent (andexanet alfa) available

Cons

  • Boxed warning against early discontinuation

  • Not approved for unstable angina or heart attack care

  • Multiple drug interactions through liver enzymes

  • Not recommended for patients with prosthetic heart valves

Lovenox

Lovenox's injectable, weight-based dosing suits acute hospital and perioperative settings, and it covers heart attack-related indications that Xarelto lacks. It requires self-injection training and carries the same bleeding and spinal warnings as other anticoagulants.

Pros

  • Approved for unstable angina and heart attack care

  • Weight-based dosing allows individualized treatment

  • Long clinical track record dating back to 1993

  • Easy to use short-term in hospital settings

Cons

  • Requires self-injection training

  • Not approved for atrial fibrillation stroke prevention

  • Injection site bruising and pain are common

  • No oral form available

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