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Aspirin vs. Xarelto: What's the difference?
- Aspirin and Xarelto (rivaroxaban) are anticoagulants used to prevent blood clots (antithrombotics).
- Aspirin is also used to treat fever, pain, and inflammation in the body.
- Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) and Xarelto is an anticoagulant (blood thinner).
- Brand names for aspirin include Bayer Aspirin, Ecotrin, and E.C. Prin.
- Aspirin is available over-the-counter (OTC) and as a generic.
- Side effects of aspirin that are different from Xarelto include abdominal pain, abdominal burning, cramping, gastritis, stomach ulcers, nausea, ringing in the ears, rash, dizziness, serious gastrointestinal bleeding, liver toxicity, kidney impairment, and spinning sensation (vertigo).
- Side effects of Xarelto that are different from aspirin include bleeding, back pain, itching, and elevated levels of liver enzymes
What is aspirin? What is Xarelto?
Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) used for treating fever, pain, and inflammation. Aspirin is also used to prevent blood clots (antithrombotic). Other NSAIDs include ibuprofen (Motrin), nabumetone (Relafen), and indomethacin (Indocin). NSAIDs work by reducing levels of prostaglandins, chemicals that are released when there is inflammation that cause pain and fever. NSAIDs block cyclooxygenase, the enzyme that makes prostaglandins, causing lower concentrations of prostaglandins, and resulting in reduced levels of inflammation, pain, and fever. Reduction of prostaglandins also diminishes the function of platelets and the ability of the blood to clot. Aspirin inhibits the function of platelets for prolonged periods of time so it is used to reduce the risk of another stroke or heart attack in patients who have had a previous stroke or heart attack.
Xarelto (rivaroxaban) is an oral anticoagulant (blood thinner) used to prevent and treat blood clots. Xarelto is a selective inhibitor of factor Xa, an enzyme necessary to form blood clots. Xarelto is used to reduce the risk of stroke and blood clots in patients with atrial fibrillation not due to a heart valve problem; to treat and reduce the risk of deep vein thrombosis (DVT, blood clots in the veins of the legs) and pulmonary embolism (PE, blood clots in the lungs); and reduce the risk of blood clots in the legs and lungs of patients who have just had hip or knee replacement surgery. Xarelto, in combination with aspirin, is indicated to reduce the risk of major cardiovascular events (cardiovascular death, myocardial infarction, and stroke) in patients with chronic coronary artery disease or peripheral artery disease.
What are the side effects of aspirin and Xarelto?
Most patients benefit from aspirin and other NSAIDs with few side effects. However, serious side effects can occur and generally 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 are
- abdominal burning,
- gastritis, and
- even serious gastrointestinal bleeding and
- liver toxicity.
Ringing in the ears
- Should ringing in the ears occur, the daily dose should be reduced.
Other side effects include:
Other side effects and adverse reactions
- Aspirin should be avoided by patients with peptic ulcer disease or poor kidney function, since this medication can aggravate both conditions.
- Aspirin may exacerbate asthma.
- Aspirin can raise the blood uric acid level and is avoided in patients with hyperuricemia and gout.
- Children and teenagers should avoid aspirin for symptoms of the flu or chickenpox because of the associated risk of Reye's Syndrome, a serious disease of the liver and nervous system that can lead to coma and death.
- Aspirin can increase the effect of medicines used to treat diabetes mellitus, resulting in abnormally low blood sugars if blood sugar levels are not monitored.
- NSAIDs should be discontinued prior to elective surgery because of a mild tendency to interfere with blood clotting. Aspirin, because of its prolonged effect on platelets, is best discontinued at least ten to fourteen days in advance of the procedure.
The most common side effect of Xarelto is bleeding. The risk of bleeding is higher when Xarelto is taken with medicines such as aspirin or aspirin-containing products, nonsteroidal anti-inflammatory drugs (NSAIDS), warfarin (Coumadin, Jantoven), heparin, clopidogrel (Plavix), and other medicines used to prevent or treat blood clots.
Some rare but serious cases of bleeding and paralysis have been reported with the use of Xarelto in patients undergoing spinal or epidural procedures. The risk is highest in patients who have problems with their spine, use indwelling epidural catheters, have had spinal surgery, or use other medicines that prevent clotting or make them more likely to bleed.
Other common side effects of Xarelto include:
- Back pain
- Elevated levels of liver enzymes
Serious side effects of Xarelto include:
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What is the dosage for aspirin vs. Xarelto?
- 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; 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.
- To reduce the risk of stroke in nonvalvular atrial fibrillation, patients with creatinine clearance (a measure of kidney function) >50 ml/min should be given 20 mg once a day with the evening meal. (Xarelto is better absorbed if it is given with food.) Patients with creatinine clearance between 15 to 50 ml/min should be given 15 mg once a day with the evening meal.
- To treat blood DVT or pulmonary embolism, 15 mg is administered by mouth twice daily with food for the first 21 days, followed by 20 mg once daily with food for 6 months.
- To reduce the risk of recurrence of DVT or pulmonary embolism, 20 mg should be administered by mouth once daily with food.
- To prevent DVT following hip replacement surgery, 10 mg is administered by mouth once daily for 35 days.
- To prevent DVT following knee replacement surgery, 10 mg is administered by mouth once daily for 12 days.
- When switching from warfarin (Coumadin) to rivaroxaban, warfarin should be stopped and then rivaroxaban started as soon as the international normalized ratio (a measure of the effects of warfarin) is < 3.0.
- When switching from blood thinning medicines other than warfarin to rivaroxaban, rivaroxaban should be started up to 2 hours before or at the time of the next scheduled evening dose.
- Use of rivaroxaban is not recommended in patients with moderate (Child-Pugh B) and severe (Child-Pugh C) liver disease or another type of liver disease associated with blood disorders.
- To avoid serious side effects rivaroxaban should not be used in patients with significantly reduced kidney function defined as creatinine clearance <30 ml/min.
- Patients who are having difficulty swallowing whole tablets can crush the 10 mg, 15 mg, and 20 mg tablets and mix with applesauce immediately before use.
- • Note: While the 15 and 20 mg tablets should be taken with food, the 10 mg tablets can be taken with or without food.
What drugs interact with aspirin and Xarelto?
Aspirin is associated with several suspected or probable interactions that affect the action of other drugs. The following examples are the most common of the suspected interactions.
Aspirin may reduce the blood pressure lowering effects of blood pressure medications. This may occur because prostaglandins have a role in the regulation of blood pressure.
When aspirin is used in combination with methotrexate (Rheumatrex, Trexall) or aminoglycoside antibiotics (for example, gentamicin) the blood levels of the methotrexate or aminoglycoside may increase, presumably because their elimination from the body is reduced. This may lead to more methotrexate or aminoglycoside-related side effects.
Individuals taking oral blood thinners or anticoagulants, for example, warfarin, (Coumadin) should avoid aspirin because aspirin also thins the blood, and excessive blood thinning may lead to serious bleeding.
The CYP3A4 liver enzymes and P-glycoprotein (P-gp) drug transporter systems are primarily responsible for metabolizing and removing Xarelto from the body. Taking Xarelto with medicines that alter the activity of both the CYP3A4 enzymes and P-gp drug transporters may affect blood levels of Xarelto. Xarelto should not be taken with:
- ketoconazole (Nizoral),
- ritonavir (Norvir),
- clarithromycin (Biaxin),
- erythromycin (Ery-Tabs),
- fluconazole (Diflucan),
- carbamazepine (Tegretol),
- phenytoin (Dilantin),
- rifampin (Rimactane), or,
- St. John's Wort.
Xarelto should not be used with other blood thinners due to the increased risk of bleeding.
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Are aspirin and Xarelto safe to use when pregnant or breastfeeding?
- Aspirin is generally avoided during pregnancy because it may adversely affect the fetus. However, low aspirin doses have been safely used for the prevention of complications of pregnancy.
- Aspirin is excreted into breast milk and may cause adverse effects in the infant.
- Due to the lack of conclusive safety data, Xarelto should be used in pregnancy only if the potential benefit justifies the potential risk to the fetus. Xarelto is classified as FDA pregnancy risk category C (animal studies show harm but there are no adequate studies in humans).
- It is not known if Xarelto is excreted in breast milk. Because many drugs enter human milk and have the potential of causing harm to the nursing baby, Xarelto should be used cautiously in nursing mothers.
Aspirin and Xarelto (rivaroxaban) are anticoagulants used to prevent blood clots (antithrombotics). Aspirin is also used to treat fever, pain, and inflammation in the body. Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) and Xarelto is an anticoagulant (blood thinner).
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Related Disease Conditions
Deep Vein Thrombosis (DVT, Blood Clot in the Legs)
Deep vein thrombosis (DVT) is a blood clot in the deep veins, and can be caused by broken bones, trauma to a limb, immobility, medications, smoking, cancer, genetic predisposition, and cancer. Symptoms of a deep vein thrombosis in a leg are swelling, tenderness, redness, warmth, and pain. Treatments for DVT include medications and surgery.
A stroke is an interruption of the blood supply to part of the brain caused by either a blood clot (ischemic) or bleeding (hemorrhagic). Symptoms of a stroke may include: weakness, numbness, double vision or vision loss, confusion, vertigo, difficulty speaking or understanding speech. A physical exam, imaging tests, neurological exam, and blood tests may be used to diagnose a stroke. Treatment may include administration of clot-busting drugs, supportive care, and in some instances, neurosurgery. The risk of stroke can be reduced by controlling high blood pressure, high cholesterol, diabetes, and stopping smoking.
Stroke vs. Mini-Stroke (TIA) Differences
A stroke or "brain attack" occurs when a blood clot or artery ruptures within the brain. The rupture or clot causes brain cell damage or death. A mini-stroke (TIA, transient ischemic attack) is caused by brain cells that dysfunctional over a short period. Stroke and mini-stroke warning signs of stroke and mini stroke are the same, and include, speech problems, weakness, numbness, and facial droop. Side effects of stroke may be permanent and you may never regain full function of the parts of the body affected. Mini-stroke side effects usually resolve within minutes to a couple of days. A transient ischemic attack (mini-stroke) is a precursor for stroke because 40% of individuals who have a mini-stroke will have a stroke within a year. Treatment of stroke depends upon the type and parts of the body affected.
Pulmonary Embolism (Blood Clot in the Lung)
A pulmonary embolism (PE) occurs when a piece of a blood clot from deep vein thrombosis (DVT) breaks off and travels to an artery in the lung where it blocks the artery and damages the lung. The most common symptoms of a pulmonary embolism are shortness of breath, chest pain, and a rapid heart rate. Causes of pulmonary embolism include prolonged immobilization, certain medications, smoking, cancer, pregnancy, and surgery. Pulmonary embolism can cause death if not treated promptly.
Early Warning Signs and Symptoms of Stroke (FAST)
Stroke is a serious medical condition. If you think you or someone you know is having a stroke call 911 immediately. There are two main types of strokes, hemorrhagic and ischemic (the most common type). A hemorrhagic stroke occurs due to a blood vessel rupture in the brain. An ischemic stroke occurs when a blood clot becomes lodged in a blood vessel in the brain, which causes a loss of blood supply to the brain, possibly causing brain tissue death. FAST is an acronym that helps people identify stroke signs and symptoms so they can act fast and call 911. Face drooping, Arm weakness, and Speech difficulty are indicators that a person may be having a stroke and it is Time to seek emergency medical treatment. Additional signs and symptoms of stroke may include weakness, difficulty walking, blurred vision, dizziness, headache, confusion, difficulty speaking, and loss of sensation. Stroke is a major cause of death and disability in the U.S. Early identification and treatment of stroke helps reduce the risk of morbidity and mortality.
Blood Clots (in the Leg)
Blood clots can occur in the venous and arterial vascular system. Blood clots can form in the heart, legs, arteries, veins, bladder, urinary tract and uterus. Risk factors for causes of blood clots include high blood pressure and cholesterol, diabetes, smoking, and family history. Symptoms of a blood clot depend on the location of the clot. Some blood clots are a medical emergency. Blood clots are treated depending upon the cause of the clot. Blood clots can be prevented by lowering the risk factors for developing blood clots.
Transient Ischemic Attack (TIA, Mini-Stroke)
When a portion of the brain loses blood supply, through a blood clot or embolus, a transient ischemic attack (TIA, mini-stroke) may occur. If the symptoms do not resolve, a stroke most likely has occurred. Symptoms of TIA include: confusion, weakness, lethargy, and loss of function to one side of the body. Risk factors for TIA include vascular disease, smoking, high blood pressure, high cholesterol, and diabetes. Treatment depends upon the severity of the TIA, and whether it resolves.
Migraine and Stroke (Symptoms, Types, Causes, Treatment)
Migraine headache is a type of headache in which the exact cause is not known; however, they may be inherited, and certain foods and environmental factors can trigger and may contribute them. A stroke (brain attack) happens when a blood vessel in the brain leaks, bursts, or becomes blocked, which can be caused by many other health problems. Both migraines and strokes can can cause severe head pain (migraine pain usually is only on one side of the head). Migraine aura symptoms may mimic or feel like a stroke or mini-stroke (transient ischemic attack, TIA) because they have similar symptoms and signs like severe headache, numbness in the legs, feet, arms, hands, or face, nausea, vomiting, and dizziness. Other migraine aura symptoms include vision problems like flashing lights or blind spots in one eye. The main difference between migraine headache and stroke symptoms and signs is that a migraine headaches usually come on gradually while a stroke symptoms come on suddenly and unexpectedly. A migraine may cause photophobia (sensitivity to light and sound). Migraine triggers include hormonal changes, alcohol, insomnia, caffeine, stress, anxiety, bright lights, loud noises, strong odors, aspartame, MSG, and changes in the weather. Symptoms of a stroke that do not occur with migraines include confusion, speech, vision, and balance problems. You can have a migraine headache and a stroke at the same time, but migraines do not cause strokes. However, in certain individuals with migraines with auras there may be related to a higher risk of stroke. Stroke is a medical emergency. If you have stroke symptoms, call 9-1-1 and get medical attention immediately.
Heart Attack vs. Stroke Symptoms, Differences, and Similarities
Heart attack usually is caused by a clot that stops blood flow supplying oxygen to an area of heart muscle, which results in heart muscle death. Stroke or "brain attack" is caused by a loss of blood supply to the brain (usually a blood clot) or by hemorrhagic stroke (bleeding within the brain), which results in brain tissue death. Both heart attack and stroke usually come on suddenly, produce similar symptoms, can be disabling, and can be fatal. The classic symptoms and warning signs of heart attack are different. Classic heart attack warning signs are chest pain or discomfort, shortness of breath, pain that radiates to the shoulders, back, arms, belly, jaw, or teeth, sweating, fainting, and nausea and vomiting. Moreover, woman having a heart attack may have additional symptoms like abdominal pain or discomfort, dizziness, clammy skin, and moderate to severe fatigue. The classic symptoms and warning signs that a person is having a stroke are confusion or loss of consciousness, sudden severe headache, speech problems, problems seeing out of one or both eyes, and numbness or weakness of only one side of the body. Moreover, a woman having a stroke may have additional warning symptom and signs like shortness of breath, disorientation, agitation, behavioral changes, weakness, nausea, vomiting, seizures, and hiccups. Recognition of stroke symptoms is vital for emergency treatment. The acronym "FAST" stands for recognition of Facial drooping, Arm weakness, Speech difficulty, and a Time for action. If you experience the symptoms heart attack or stroke (FAST) or see them develop in another person, then contact 911 immediately.
Stroke vs Aneurysm (Differences and Similarities)
A stroke or "brain attack" is caused because blood flow to an area of the brain has been cut off by a blood clot or by a weakened or damaged blood vessel (for example, head trauma). The damaged area of the brain dies, which results in loss of function like speech capabilities, muscle movement, or muscles of an extremity like an arm or leg is reduced or lost completely. An aneurysm is a weakness in an artery wall. This weakness in the wall causes the artery to widen or balloon out, and then they rupture or break open. A person with an brain aneurysm generally won't have any symptoms until it becomes a problem. The symptoms and signs are similar to a stroke.Symptoms and signs of a stroke include: Vision problems Severe headache with no known cause Loss of memory Trouble getting words out Trouble typing, texting, or other coordination problems Both the American Heart Association and the American Stroke Association recommend using the FAST system to recognize and treat strokes. If you think someone may be having a stroke, remember FAST! F - Facial drooping A - Arm weakness S - Speech difficulty T - time - DO NOT DELAY. Call 911.If you think someone is having a stroke or aneurysm call 911 immediately. Both conditions require medical treatment. The prognosis for both diseases depend on the extent of the damage to the brain and any other affected areas of the body.
Stroke is the third leading killer in the United States. Some of the warning signs of stroke include sudden confusion, trouble seeing with one or both eyes, dizziness, loss of balance, and more. Stroke prevention and reatable risk factors for stroke include lowering high blood pressure, quit smoking, heart disease, diabetes control and prevention.
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