Aspirin vs. Xarelto (rivaroxaban)

Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) used to treat fever, pain, and inflammation. It is also used to prevent blood clots. Other NSAIDs include ibuprofen, nabumetone, and indomethacin. NSAIDs reduce levels of prostaglandins, chemicals released during inflammation that cause pain and fever. By blocking cyclooxygenase, the enzyme that produces prostaglandins, NSAIDs lower concentrations of prostaglandins, resulting in reduced inflammation, pain, and fever. Aspirin also inhibits platelet function, reducing the risk of stroke or heart attack in patients with previous stroke or heart attack.

Xarelto is an oral anticoagulant used to prevent and treat blood clots. It is a selective inhibitor of factor Xa, an enzyme necessary for clot formation. Xarelto is prescribed for patients with atrial fibrillation not due to a heart valve problem to reduce the risk of stroke and blood clots. It is also used to treat deep vein thrombosis and pulmonary embolism, as well as to prevent blood clots after hip or knee replacement surgery. In combination with aspirin, Xarelto is indicated to reduce the risk of major cardiovascular events in patients with chronic coronary artery disease or peripheral artery disease.

QUESTION

What are the side effects of aspirin and Xarelto?

Aspirin

Most patients benefit from aspirin and other NSAIDs with few side effects. However, serious side effects can occur and tend to be dose-related. Therefore, it is advisable to use the lowest effective dose to minimize side effects.

The most common side effects of aspirin involve the gastrointestinal system and ringing in the ears.

Gastrointestinal side effects include ulcerations, abdominal burning, pain, cramping, nausea, gastritis, and serious gastrointestinal bleeding and liver toxicity.

Ulceration and bleeding can occur without abdominal pain. Black tarry stools, weakness, and dizziness upon standing may be the only signs of internal bleeding.

Ringing in the ears can be reduced by reducing the daily dosage.

Other side effects include aggravation of peptic ulcer disease or poor kidney function, exacerbation of asthma, increased blood uric acid level in patients with hyperuricemia and gout, increased effect of diabetes medications leading to low blood sugar, and mild interference with blood clotting, which necessitates discontinuing aspirin prior to elective surgery.

Xarelto

The most common side effect of Xarelto is bleeding. The risk of bleeding is higher when Xarelto is taken with other medicines that prevent or treat blood clots. Some rare but serious cases of bleeding and paralysis have been reported with Xarelto use in patients undergoing spinal or epidural procedures. Risk factors include spinal problems, indwelling epidural catheters, prior spinal surgery, or use of other medicines that affect clotting or increase the risk of bleeding. Other common side effects include back pain, itching, and elevated liver enzymes. Serious side effects include severe bleeding, hepatitis, decreased platelets, allergic reactions, and Stevens-Johnson syndrome.

What is the dosage for aspirin vs. Xarelto?

Aspirin

• Aspirin should be taken with food. Doses range from 50 mg to 6000 mg daily depending on the use.
• Usual doses for mild to moderate pain are 350 or 650 mg every 4 hours or 500 mg every 6 hours.
• Doses for rheumatoid arthritis include 500 mg every 4-6 hours, 650 mg every 4 hours, 1000 mg every 4-6 hours, and 1950 mg twice daily.
• Heart attacks are prevented with 75, 81, 162 or 325 mg daily.
• 160 to 325 mg of non-enteric coated aspirin should be chewed immediately when experiencing symptoms of a heart attack.
• The dose for preventing another stroke is 75 to 100 mg daily.

Xarelto

• To reduce the risk of stroke in nonvalvular atrial fibrillation, the recommended dosages vary depending on kidney function.
• To treat blood DVT or pulmonary embolism, a 15 mg dose is administered orally twice daily with food for the first 21 days, followed by a 20 mg dose once daily with food for 6 months.
• To reduce the risk of recurrence of DVT or pulmonary embolism, a 20 mg dose is administered orally once daily with food.
• To prevent DVT following hip replacement surgery, a 10 mg dose is administered orally once daily for 35 days.
• To prevent DVT following knee replacement surgery, a 10 mg dose is administered orally once daily for 12 days.
• When switching from warfarin to Xarelto, warfarin should be stopped and Xarelto started once the international normalized ratio is < 3.0.
• When switching from other blood thinners to Xarelto, Xarelto should be started up to 2 hours before or at the time of the next scheduled evening dose.
• Use of Xarelto is not recommended in patients with moderate and severe liver disease or other liver disease associated with blood disorders.
• Xarelto should not be used in patients with significantly reduced kidney function.
• Patients who have difficulty swallowing whole tablets can crush the 10 mg, 15 mg, and 20 mg tablets and mix with applesauce immediately before use.
• Note: The 15 and 20 mg tablets should be taken with food, but the 10 mg tablets can be taken with or without food.

What drugs interact with aspirin and Xarelto?

Aspirin

Aspirin may interact with other drugs, affecting their action. For example, NSAIDs may increase blood levels of lithium, reduce the blood pressure lowering effects of blood pressure medications, increase blood levels of methotrexate or aminoglycoside antibiotics, and interfere with the action of oral blood thinners or anticoagulants.

Xarelto

Xarelto should not be taken with drugs that alter the activity of CYP3A4 enzymes and P-gp drug transporters, as it may affect blood levels of Xarelto. Medicines to avoid include ketoconazole, ritonavir, clarithromycin, erythromycin, fluconazole, carbamazepine, phenytoin, rifampin, and St. John’s Wort. Xarelto should also not be used with other blood thinners.

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Are aspirin and Xarelto safe to use when pregnant or breastfeeding?

Aspirin

• Aspirin should be avoided during pregnancy, but low doses can be used for the prevention of complications.
• Aspirin is excreted into breast milk and may cause adverse effects in the infant.

Xarelto

• Xarelto should be used in pregnancy only if the potential benefit justifies the potential risk to the fetus. It is classified as FDA pregnancy risk category C.
• It is not known if Xarelto is excreted in breast milk. Caution should be exercised when using Xarelto in nursing mothers.

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Summary

Aspirin and Xarelto (rivaroxaban) are anticoagulants used to prevent blood clots. Aspirin is also used to treat fever, pain, and inflammation. Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) and Xarelto is an anticoagulant (blood thinner).