Warfarin vs. Rivaroxaban

Instructor: Alyssa Campbell

Alyssa is an active RN and teaches Nursing and Leadership university courses. She also has a Doctorate in Nursing Practice and a Master's in Business Administration.

Both warfarin and rivaroxaban are effective medications in preventing unwanted blood clots from forming within the body. Read this lesson to compare and contrast both drugs in terms of how they work, the need for blood level monitoring, and the use of available antidotes.

The Selection Process

Jeff Snyder, a nurse practitioner working in a primary care office, is scheduled to see Mr. Jerron this morning for his annual checkup. Nurse Snyder greets Mr. Jerron and explains that he will conduct an assessment, consisting of a few interview-style questions and use of his stethoscope to listen to his heart, lungs, and bowels.

Upon placing his stethoscope up to the left side of Mr. Jerron's front chest, Nurse Snyder immediately recognizes the irregular heart rhythm known as atrial fibrillation. The nurse explains that atrial fibrillation may cause blood to pool in his patient's heart, making him prone to blood clots. A few other risks for the development of clots include:

  • History of stroke
  • Smoking
  • Obesity
  • Venous stasis, or pooling of blood related to poor circulation

Because the atrial fibrillation increases Mr. Jerron's risk for deep vein thrombosis (DVT) and pulmonary embolism, Nurse Snyder considers recommending a blood thinning medication to prevent future life-threatening conditions.

How They Work

Nurse Snyder considers two popular medications -- warfarin and rivaroxaban -- to be prescribed for Mr. Jerron. Known as blood thinners, these two types of medications both impact the body's ability of blood to clot normally. In doing so, the risk of blood clots circulating in the blood stream is minimized, but excessive bleeding may occur.

Upon weighing the pros and cons of each medication with Mr. Jerron, Nurse Snyder first explains how the two medications impact the clotting cascade, or the body's natural process of blood clotting.


Warfarin is an older drug prescribed to reduce the risk of dangerous blood clotting that could result in stroke or DVT. Heavily affecting many process points in the coagulation cascade, it also interferes with the normal clotting process by blocking vitamin-K intake, an important vitamin in normal blood clot formation.


Rivaroxaban is a much newer drug that can be taken in place of warfarin. Like warfarin, it prevents the formation of harmful clots, but does so by only disturbing the final process in the clotting cascade. By preventing the process of fibrin creation, rivaroxaban inhibits clots by blocking the fibrin that makes blood cells stick together.

Blood Level Monitoring

To ensure that Mr. Jerron chooses the right medication for himself, Nurse Snyder explains the need for blood level monitoring, or blood work, to be taken regularly with the use of warfarin. Because warfarin disturbs so many of the body's natural processes, it is considered rather unstable when compared with rivaroxaban. The use of warfarin may require daily or weekly blood work until an initial therapeutic, or safe, blood level has been attained. To make sure Mr. Jerron's blood levels remain not too thin and not too thick, he will need blood work drawn for the rest of his life. Rivaroxaban does not require ongoing blood level monitoring, making it much easier to adapt to.

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