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
Lovenox
Xarelto vs. Lovenox Dosage
Xarelto
Lovenox
| 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 | 1 mg/kg twice daily | At the start |
| Maximum dose | 40 mg once daily | If needed |
| Dose changes | 3 increases | 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 |
Lovenox
| 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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