Skip to main content
Drug vs. Drug

Xarelto vs. warfarin: Uses, cost, coverage, and side effects

Compare Xarelto vs. warfarin to see how they differ in cost, side effects, drug interactions, and treatment effectiveness.
By | May 27, 2025
Two Rx pills comparing Xarelto vs. warfarin

Key takeaways

  • Xarelto and warfarin are both FDA-approved, prescription blood thinners used to treat and prevent certain clotting disorders. However, they each work differently and have different safety profiles.

  • Xarelto is generally considered safer and more effective than warfarin for preventing venous thromboembolism and stroke, according to studies. Xarelto also requires less monitoring, has fewer interactions, and has a more consistent dosing schedule than warfarin.

  • Warfarin is a generic medication, while Xarelto is a brand-name medication. Because of this, Xarelto typically costs more than warfarin.

In this article:

Xarelto and warfarin are two prescription blood thinners that are used to prevent and treat blood clotting disorders. Xarelto is a brand-name medication, while warfarin is a generic. While they are used for similar conditions, Xarelto and warfarin work differently. Xarelto belongs to a class of drugs called factor Xa inhibitors and works by blocking factor Xa—a protein in the blood—to prevent the formation of blood clots. Warfarin is a vitamin K antagonist that stops the production of clotting factors—or proteins involved in blood clotting. This slows down the body’s ability to form blood clots. Although both drugs are known as anticoagulants, or blood thinners, they have some major differences. In this article, we’ll cover the main differences between Xarelto and warfarin. 

Compare Xarelto vs. warfarin key differences
Warfarin Xarelto
Drug class Vitamin K antagonist Factor Xa inhibitor
Brand/generic status Generic Brand
What is the generic/brand name? Coumadin, Jantoven Rivaroxaban
What form(s) does the drug come in? Tablet Tablet, oral suspension
What is the standard dosage? Varies depending on INR blood test results 10 mg to 20 mg once daily or 2.5 mg twice daily
How long is the typical treatment? Varies Varies
Who typically uses the medication? Adults Adults and children

Conditions treated by Xarelto and warfarin

Xarelto and warfarin have overlapping indications, however, Xarelto may be prescribed for other conditions as well. 

Xarleto is FDA approved to:

  • Lower the risk of stroke and embolism (blockage in a blood vessel) in patients with nonvalvular atrial fibrillation
  • Treat deep vein thrombosis (DVT) and pulmonary embolism (PE)
  • Reduce the risk of repeat DVT and PE following initial therapy
  • Prevent DVT, which can lead to PE in patients having knee or hip replacement surgery
  • Prevent venous thromboembolism (VTE) in patients with an acute medical illness
  • Lower the risk of major cardiovascular events, such as heart attack or stroke, in patients with coronary artery disease
  • Reduce the risk of major clotting events in patients with peripheral artery disease, such as after recent lower extremity revascularization
  • Treat VTE and reduce the risk of repeat VTE in children less than 18 years of age
  • Prevent VTE in children ages 2 years and older with congenital heart disease who have had a surgery called the Fontan procedure

Warfarin is FDA approved to:

  • Treat and prevent DVT and PE
  • Treat and prevent complications from atrial fibrillation and cardiac valve replacement
  • Reduce the risk of death, repeat heart attack, and clotting events after a heart attack

Is Xarelto better than warfarin?

Xarelto and warfarin are both considered safe and effective medications for their respective indications. However, direct-acting oral anticoagulants (DOACs), such as Xarelto, are usually preferred over warfarin for most people with atrial fibrillation, DVT, or PE. This is because DOACs don’t require frequent blood test monitoring, have fewer interactions, and have consistent dosing schedules. 

In a 2023 meta-analysis published in Frontiers in Surgery, researchers evaluated the safety and efficacy of Xarelto vs. warfarin for VTE. They found that Xarelto significantly reduced the incidence of VTE compared to warfarin. Xarelto also reduced nonmajor and major bleeding. There was no difference in all-cause mortality between the rivaroxaban group and warfarin group. 

Another clinical trial published in Frontiers in Cardiovascular Medicine found that Xarelto was non-inferior, or had similar efficacy, to warfarin when used to prevent stroke and embolism in patients with non-valvular atrial fibrillation with high bleeding risk. However, Xarelto was more effective in reducing fatal bleeding and bleeding in critical organs. 

With numerous anticoagulants available on the market, it can be challenging to determine which one works best for you. Results can also vary from person to person. Therefore, it is a good idea to consult with a doctor, who can discuss whether Xarelto vs. warfarin is best for you based on your medical history, other medical conditions, and existing medications. 

Xarelto vs. warfarin: Insurance coverage and cost comparison

Xarelto and warfarin are usually covered by commercial insurance and Medicare prescription drug plans, but coverage can vary by plan. The cost of each medication will also depend on the plan’s drug formulary, your coverage state, and copays. 

Without insurance, the average retail price of Xarelto is $821 for 60, 2.5 mg tablets. A SingleCare prescription discount card can lower the price to $193. The average cost of warfarin without insurance is $27 for 30, 5 mg tablets. However, a SingleCare coupon can reduce the price to as little as $4. This means warfarin may be a more cost-effective choice. To obtain the most up-to-date information, ask your insurance provider or pharmacist about how much Xarelto vs. warfarin costs. 

Compare Xarelto vs. warfarin cost and coverage
Warfarin Xarelto
Typically covered by insurance? Yes Yes
Typically covered by Medicare Part D? Yes Yes
Typically covered by Medicaid? Varies Varies
Cost without insurance $27 for 30, 5 mg tablets $821 for 60, 2.5 mg tablets
SingleCare cost See latest prices See latest prices

Save up to 80% on Warfarin with SingleCare

Different pharmacies offer different prices for the same medication. SingleCare helps find the best price for you.

Warfarin 5 mg (30 Tablet)
23666 - Hampton, VA
$3.83
Get free coupon
$4.00
Get free coupon
See Warfarin prices at all pharmacies

Xarelto vs. warfarin side effects

Because Xarelto and warfarin are blood thinners, their most common side effects are related to bleeding. These include unexplained bruising, nosebleeds, and bleeding gums. Other possible side effects of warfarin are fatigue, weakness, swelling, and headache. Common adverse effects of Xarelto include back pain, dizziness, and itching. 

Both medications can also cause serious side effects such as major or fatal bleeding. In fact, warfarin has a boxed warning about its risk of severe bleeding. Other serious side effects of warfarin include tissue necrosis, calciphylaxis (a rare, but serious skin disorder), and kidney damage.

Aside from severe bleeding, other serious side effects of Xarelto include bleeding in the eye or around the spinal cord, thrombocytopenia (low platelet counts), agranulocytosis (low white blood cell counts), and liver problems.

As with all medications, severe allergic reactions can occur with Xarelto and warfarin. If you develop trouble breathing, hives, or swelling of your throat, face, tongue, or lips, get emergency medical help right away. 

Keep in mind, this is not a complete list of side effects. To learn more, ask your healthcare professional about the side effects of Xarelto vs. warfarin.

Warfarin and Xarelto drug interactions and warnings

Warfarin can interact with several substances, including drugs, foods, and beverages. This is one of the reasons warfarin has fallen out of favor in recent years. Warfarin is known to interact with drugs that increase bleeding risk, certain antibiotics, some herbal products, and many other drugs. It can also interact with foods, such as green leafy vegetables and grapefruit. Combining these substances with warfarin can either increase or decrease levels of warfarin in the body. For example, quinolone antibiotics, such as ciprofloxacin or levofloxacin, can increase the levels of warfarin in your system. This can increase your risk of bleeding. On the other hand, combining warfarin with certain anti-seizure drugs, like carbamazepine, can lower the levels of warfarin in the body. This can make warfarin less effective and increase your risk of blood clots. 

Although Xarelto doesn’t interact with as many drugs as warfarin, there are still certain drugs that you should avoid while taking it. Common drugs that may interact with Xarelto include nonsteroidal anti-inflammatory drugs (NSAIDs), certain anti-seizure drugs, some antibiotics, and St. John’s wort. Similar to warfarin’s drug interactions, combining Xarelto with these medications can either increase or decrease the levels of Xarelto in your system. 

Both Xarelto and warfarin have boxed warnings, which is the strongest warning issue by the United States Food and Drug Administration (FDA). 

  • Xarelto has two boxed warnings. The first is regarding its risk of clotting events if the drug is stopped too soon. The second is regarding its risk of spinal (bleeding around the spine) and epidural hematoma (bleeding around the brain). 
  • Warfarin has a boxed warning regarding its risk of major or fatal bleeding. 

Xarelto and warfarin have other warnings as well. Warfarin can cause harm to a fetus if taken during pregnancy. It can also cause complications in people with kidney disease. People with certain conditions can be at increased risk if they take warfarin. These include people with liver problems, infections, an indwelling catheter, moderate to severe high blood pressure, history of eye surgery, polycythemia vera (a type of blood cancer), vasculitis, and diabetes. 

Healthcare providers typically only prescribe Xarelto during pregnancy if the benefits outweigh the risks as taking the drug can increase the risk of bleeding during pregnancy and emergency delivery. Otherwise, Xarelto usually isn’t prescribed for people with prosthetic heart valves or those with a condition called triple-positive antiphospholipid syndrome.