Blood Thinners: Should I prescribe Xarelto or Warfarin?

Anticoagulants, commonly known as blood thinners, are drugs that are prescribed to prevent blood clots. Many doctors choose to prescribe either Xarelto or Warfarin to patients who are at risk of blood clotting. These two drugs both have advantages and disadvantages including costs, risks, and side effects.

Understanding Xarelto

Xarelto inhibits blood clots by inhibiting the formation of thrombin. It is a newer drug that has undergone various expansions of FDA approval. Approved uses include:

  • Reduce risk of stroke for patients with atrial fibrillation
  • Reduce blood clots following hip and knee replacement surgery
  • Treat and reduce the risk of pulmonary embolus-PE and deep vein thrombosis-DVT

The dosage is usually once a day, although there are instances where it is taken twice daily for the first few weeks. It is available in 10-milligram tablets that can be taken with or without a meal. Larger doses, such as 15- and 20-milligram tablets, should be taken with a meal.

Warfarin Facts

The first and most frequently used blood thinner is warfarin, which was developed for human use in the 1950s. Warfarin works by inhibiting blood-clotting factors caused by Vitamin K. Uses include:

  • Treat and prevent blood clots related to DVT or PE
  • Reduce atrial fibrillation
  • Reduce risk of blood clots following hip or knee replacement surgery, recent heart attack, or heart valve replacement

Patients must be monitored every few weeks while taking warfarin. Monitoring involves measuring the International Normalized Ratio (INR) with the prothrombin time test. Adjusting the dosage may be required based on INR lab results.

Comparing Side Effects

Side effects of both drugs are similar but there are a few differences. For Xarelto, easy minor bleeding or bruising may occur. Patients taking warfarin may experience loss of appetite, nausea, or abdominal pain. Serious side effects of both drugs include:

  • Serious bleeding
  • Coughing up blood
  • Bloody vomit
  • Severe headache
  • Bloody stools

Serious allergic reactions to these medications, such as swelling, rash, or itching are rare. Warfarin has rarely caused serious and potentially fatal problems if small blood clots occur and are left untreated.

Cost Differences

Warfarin is more widely available and is less expensive. It is also available in generic forms. Due to Xarelto being newer, it costs significantly more. The cost difference may be minimal if a patient is covered by insurance.

Dietary Issues

Patients taking warfarin may need to reduce consumption of foods that are rich in Vitamin K. High amounts of Vitamin K can reduce the effectiveness of warfarin. Foods that may need to be avoided or limited include:

  • Spinach
  • Kale
  • Chard
  • Broccoli

These foods may not need to be cut out completely. Consistent INR tests will reveal whether a patient’s intake of Vitamin K is negating the benefits of warfarin. Dietary issues do not affect Xarelto’s effectiveness.

Drug Interactions

Taking other drugs with either drug may reduce its effectiveness or increase side effects. Drugs that may interact with Xarelto include:

  • Antidepressants
  • Mifepristone
  • Azole antifungals
  • Conivaptan
  • HIV protease inhibitors

Warfarin may interact with:

  • Capecitabine
  • Mifepristone
  • Imatinib

Many vitamins and herbal supplements may also affect warfarin. This includes medications that are applied to skin or inside the rectum or vagina. Both Xarelto and warfarin interact with aspirins and anti-inflammatory drugs such as naproxen, ibuprofen, and celecoxib. They may increase bleeding problems if used simultaneously with these blood thinners.

Prescribing Through an In-House Pharmacy

If you are considering prescribing either Xarelto or warfarin, consider the benefits of in-house dispensing. As healthcare providers, the safety of your patients is your first priority. Having their blood thinner prescriptions available when they are already at your hospital or clinic will reduce the need for them to arrange extra transportation. This is helpful and enhances safety procedures for older and disabled patients.

It also provides convenience by saving time. Many patients do not have the time to immediately leave the clinic and drive to another pharmacy. Having an in-house pharmacy gives them a one-stop shop for treatments and medications. This also helps to ensure that their prescriptions will get filled in a timely manner.

Proficient Rx helps healthcare providers order, track and dispense medications including brand names, generic, and over-the-counter pharmaceuticals. Using our service to prescribe Xarelto and warfarin gives you and your patients increased freedom over the entire process. Next time you need to prescribe blood thinners, consider doing it through in-house dispensing.

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