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Xarelto vs Aspirin: Similarities and Differences

Monday 9 March 2020
9 minute(s) read

Table of Contents

I. What is Aspirin?

II. How Does Aspirin Work?

III. Prescribed Use

IV. Side Effects

V. Drug Interactions

VI. What is Xarelto?

VII. How Does Xarelto Work?

VIII. Prescribed Use

IX. Side Effects

X. Drug Interactions

XI. Similarities

XII. Differences

What is Aspirin?

Aspirin is the brand name for acetylsalicylic acid and is an orally administered non-steroidal anti-inflammatory agent (NSAID). It is a drug in the family of salicylates, which can be found in plants such as willow trees and myrtle.

What’s interesting about Aspirin is that it was the first synthetic NSAID drug ever made—not an exact copy of something existing in nature. It was produced in 1897 by Felix Hoffman, a German research assistant at Bayer & Co. Aspirin is perhaps one of the most commonly used medications worldwide and has been in clinical use for over 100 years. [1]

image of question mark with white pills yellow background

How Does Aspirin Work?

When there is inflammation due to fever or pain, a chemical called prostaglandin is released in the body. NSAIDs work by blocking an enzyme called cyclooxygenase, which makes prostaglandins. Lower levels of prostaglandins result in reduced inflammation and diminish the function of blood platelets. Aspirin is known as an antiplatelet drug, helping to lower the blood’s ability to clot by preventing platelets from sticking together to form a clot. Aspirin is often used to reduce the risk of heart attack and stroke.

Prescribed Use

Aspirin (an NSAID) is a medication with the following effects:

  • Analgesic: for minor pains and aches, relieves pain without anesthesia
  • Antipyretic: reduces fever
  • Anti-inflammatory: lowers inflammation
  • Antiplatelet: Given in long-term low-doses to prevent heart attack, stroke, and cancer


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In high doses, Aspirin can help treat or reduce symptoms of:

  • Fever
  • Rheumatic arthritis
  • Inflammatory joint conditions
  • Pericarditis: inflammation of the pericardium, the sac-like tissue that surrounds the heart

In low doses, Aspirin is used to:

  • Prevent the formation of blood clots
  • Reduce the risk of a transient ischemic attack (TIA)
  • Prevent heart attack in patients with cardiovascular disease
  • Prevent stroke (but not to treat)
  • Prevent colorectal cancer

People may be given aspirin if they have certain risk factors that may influence the chance of heart attack or stroke. Aspirin can be given to individuals with high blood cholesterol levels, high blood pressure, diabetes, and someone who smokes cigarettes. [2]

Side-Effects of Aspirin

Reye’s Syndrome

Aspirin should never be given to children under the age of 16 due to the risk of developing Reye’s syndrome, which typically affects children or young adults under the age of 20. Reye’s syndrome is a very rare disorder that may cause severe liver and brain damage.

But how is Reye’s syndrome caused? In most cases, aspirin was used to treat symptoms of a cold, flu, or chickenpox, for example. Because the brain is still developing at this age, there is the possibility that Aspirin can cause damage.  Initial symptoms of Reye’s include repeatedly getting sick, tiredness, rapid breathing, and seizures. [3]

Common side effects of aspirin occur in more than 1 in 100 people. Make sure to speak with your doctor if side effects persist.

Common side effects of Aspirin:

  • Mild indigestion — make sure to take aspirin with food
  • Cramping, abdominal burning
  • Nausea
  • Bleeding more easily than normal

Serious side effects include:

  • Blistered, peeling skin
  • Coughing up blood
  • Blood in stool, urine, or vomit
  • Yellow skin or yellow whites of eyes — a potential sign of a liver problem
  • Painful joints in hands and feet — a potential sign of high uric acid levels in the blood
  • Swollen hands or feet — a sign of water retention
  • Allergic reaction (anaphylaxis) — rare cases

These are not all the side effects of aspirin. Be sure to talk with your doctor for a detailed list.

Drug and Supplement Interactions

different colored pills on yellow background

Be sure to inform your doctor about any drugs and supplements you are taking. Below is a list of specific medicines to be aware of before you start taking aspirin, as directed by your doctor. Mixing aspirin with herbal remedies may cause adverse effects, as well. To be safe, speak with your doctor about any alternative or herbal remedies you are taking.

  • Anticoagulants or blood thinners such as Warfarin or Clopidogrel
  • Anti-inflammatory drugs such as ibuprofen or prednisolone
  • Immunosuppressors such as Ciclosporin and Tacrolimus, given to prevent organ rejection after transplant
  • Hypertension medications such as Furosemide and Remipril
  • Digoxin (for heart problems)
  • Lithium (for mental health problems)
  • Acetazolamide (for glaucoma)
  • Methotrexate (used to manage the immune system, and treat some cancers)
  • Diabetes medications such as insulin and Gliclazide

What is Xarelto?

Xarelto is an oral anticoagulant, also known as a blood thinner. Rivaroxaban is the name of the active ingredient in Xarelto. One of the most common uses for Xarelto is in the prevention of blood clots, specifically deep vein thrombosis in the legs and pulmonary embolism in the lungs, post knee or hip replacement surgery.

How Does Xarelto Work?

Xarelto is used to treat or prevent blood clots from occurring. This drug helps to prevent blood clots from forming by inhibiting the activity of factor Xa, which is responsible for blood clotting. When factor Xa is blocked, thrombin decreases. Thrombin is an enzyme in the blood that promotes blood clotting. Therefore, when factor Xa is blocked, thrombin decreases, and this helps to prevent blood clots. [4]

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Prescribed Use

There are a handful of times when Xarelto may be the doctor's medication of choice for a prescription. 

Xarelto is used to:

  • Prevent or treat a type of blood clot called deep vein thrombosis (DVT)
  • Prevent pulmonary embolism (PE) which are blood clots in the lungs — previous DVT can lead to a PE
  • After knee or hip replacement surgery, to prevent a DVT or PE
  • To lower risk of a DVT or PE coming back after patient has received treatment for blood clots for at least 6 months
  • In patients with atrial fibrillation (heart rhythm disorder) to lower risk of stroke caused by a blood clot
  • In patients hospitalized for an acute illness with an increased risk of getting blood clots, who do not have a high risk of bleeding
  • Sometimes Xarelto is paired with Aspirin in people with coronary artery disease or peripheral artery disease
  • In the instances listed above, Xarelto is used to prevent blood clots, stroke, heart attack, and serious heart problems. [5]

neon sign reading prescription

Side Effects

Common side effects of Xarelto include:

  • Muscle pain
  • Pain in the arms and legs
  • Joint pain
  • Itching

More severe side effects of Xarelto may include:

  • Bruising easily
  • Increased bleeding such as nosebleeds, bleeding gums
  • Bleeding that does not stop
  • Headaches, dizziness
  • Muscle and leg weakness
  • Red, pink, or dark brown urine
  • Red or black, tarry stools
  • Vomiting blood, or vomit that looks like coffee grounds
  • Pain, swelling, or new drainage at wound sites
  • Paralysis
  • Spinal blood clot

This is not a complete list of side effects related to Xarelto. For a more comprehensive description of side effects, read this page. 

Drug Interactions

There is a long list of medications that can interact with Xarelto. Different interactions can cause different effects; some interfere with Xarelto’s action, while others increase certain side effects. Some foods may interact with the drug as well. 

Use caution when using these classes of drugs while taking Xarelto: 

  • NSAIDs
  • Antiplatelet drugs such as Aspirin
  • Anticoagulant drugs such as Warfarin, Heparin, and Enoxaparin
  • HIV drugs
  • Antifungal drugs
  • Tuberculosis drugs
  • Herbal supplements such as St. John’s wort
  • Seizure drugs
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs) [4]

To learn more about drug and food interactions associated with Xarelto here is a more thorough explanation (insert interaction article).


Both Xarelto and Aspirin work to prevent blood clots from forming to protect against heart attack or stroke. It may be recommended by your doctor to take Xarelto, Aspirin, or another anticoagulant or antiplatelet drug if you have the following conditions. Each of these conditions increases the risk of clot formation: [6]

  • Congenital heart defect
  • Abnormal heartbeat
  • Problems with blood circulation
  • Heart disease

In patients with chronic coronary artery disease (CAD) or peripheral artery disease (PAD), Xarelto and Aspirin may be prescribed together by a doctor. It is not recommended to take Xarelto and Aspirin together always due to the blood-thinning effect of both medications. Around three percent of people taking Xarelto (2.5mg tablets) with low-dose aspirin experienced a major bleeding event. [7]

In the instances of CAD or PAD, Xarelto and Aspirin may be combined to reduce the risk of major cardiovascular events such as heart attack (myocardial infarction), stroke, or cardiovascular death. [8]


As mentioned above, Xarelto and Aspirin work to prevent blood clots. But these medications prevent blood clots in slightly different ways.

Antiplatelet vs. Anticoagulant

Aspirin is an antiplatelet drug. Antiplatelets lower the blood’s ability to clot by preventing platelets from sticking together and forming clots. This class of medicines interferes specifically with the binding of platelets.

Xarelto is an anticoagulant. Anticoagulants lower the blood’s ability to clot by stopping specific proteins and enzymes, also known as clotting factors, from helping blood clots to form. Xarelto specifically interferes with binding factor Xa, whereas different anticoagulants interfere with various binding factors to prevent clotting.

Non-Generic vs. Generic

Xarelto is strictly a prescription drug with no generic form of the drug available. Aspirin is a prescription and over-the-counter drug with many generic forms of the medication available, with brand names such as Ecotrin, Aspir 81, and Bayer’s Aspirin.


Aspirin is often taken for pain, headache, and fever, as well as to prevent more serious conditions related to cardiovascular risk for stroke and heart attack. Xarelto is not prescribed for everyday pains such as headache and fever but more specific conditions such as heart rhythm problems and post knee and hip replacement surgery to prevent a DVT or PE. 

Side Effects

Another difference between Aspirin and Xarelto has to do with the side effects of these drugs. More commonly reported side effects of Aspirin are gastrointestinal, such as cramping, nausea, and ulcers. A more severe side effect of Aspirin is gastrointestinal bleeding. Common side effects of Xarelto may include back pain, increased bleeding of the gums, and more severely, spinal blood clots and excessive bleeding that may not stop.

Learn more about the instances where Xarelto may be used in place or alongside Aspirin. 

The content in this article is intended for informational purposes only. This website does not provide medical advice. In all circumstances, you should always seek the advice of your physician and/or other qualified health professionals(s) for drug, medical condition, or treatment advice. The content provided on this website is not a substitute for professional medical advice, diagnosis or treatment.