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Warfarin vs. Xarelto: Is One Safer?

Well-known and widely used anticoagulants, including Xarelto and Warfarin, are used to help individuals with serious conditions including stroke and pulmonary embolism thin their blood. Among other less serious side effects, the most concerning is internal bleeding.

What is an anticoagulant?

Anticoagulant drugs, or blood thinners, do just that: they thin the blood and prevent clots from forming. Clots often occur in veins and arteries, which can lead to Deep Vein Thrombosis, Pulmonary Embolism and stroke among other complications. Blood can clot because of different kinds of cancer and their treatment methods, as well as various lifestyle risk factors including: 

  • Pregnancy
  • Obesity
  • Oral birth control
  • Being a smoker
  • Immobility
  • Being over the age of 60
  • Family history
  • Diabetes
  • High blood pressure and/or cholesterol

Blood clots are one of the most preventable kinds of blood conditions, and many people choose medications like Xarelto to thin their blood over options like lifestyle changes and drugs that require testing for the dose.

No antidote for Xarelto

Xarelto, made by Bayer, has been on the market for several years. Its popularity has been staggering: Bayer made $1.3 billion in sales of the drug in 2013 alone. The older drug Warfarin is very similar, although there are some key differences - mostly in their side effects. Xarelto's include itching, bruising easily, muscle pain and numbness. The biggest side effect is severe internal bleeding, which can sometimes lead to death.

There is no antidote to severe internal bleeding on Xarelto, as opposed to Warfarin, which uses Vitamin K and prothrombin complex concentrate to manage bleeding. The drug (called rivaroxaban and marketed as Xarelto) was on the FDA's Adverse Events Reporting System list in 2015 as the drug with the highest number of serious injury of any regularly monitored drug.

Warfarin is well-known; what about the others?

Warfarin, also known as Coumadin and Jantoven, has been around since the 1950s as an anticoagulant much like Xarelto. It can also cause severe bleeding and other side effects similar to Xarelto; however, as mentioned before, there are antidotes to stop the internal bleeding. Since the drug has been around for so long, it's been tested and studied over and over, and doctors are very familiar with its used and side effects. Instead of standard doses, Warfarin requires a doctor to test a patient, dose them and monitor to make sure the drug is working - it's more personalized than Xarelto, but has many of the same side effects and risks.

Since Warfarin requires rigorous testing and monitoring, many doctors wanted a new drug that would offer the same results - thus, the newer anticoagulants were developed. These are often called new oral anticoagulants, or NOACs - Xarelto is part of the "new and improved" lot of medications. They're marketed to doctor and consumers as an improvement on Warfarin - but can they really be if they have such severe side effects and no antidote to the most deadly?

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