The drawbacks of early anticoagulants paved the way for a newer class of blood thinners, like Xarelto. However, Xarelto may have safety risks that could outweigh the inconveniences of older blood thinner medication.

Blood thinners are a class of drugs that interfere with the body’s ability to form blood clots. While blood clots are a normal part of the healing process, when blood clots form inside the body, they can block the flow of blood to vital organs, causing stroke, pulmonary embolism, and heart attacks depending on where the errant clot ends up.

When an individual has a risk of forming dangerous blood clots that cannot be ignored, such as in the case of atrial fibrillation, drugs like Xarelto are administered to reduce this risk. But these new blood thinners have risks of their own.

Before Xarelto came onto the scene, older blood thinners like Warfarin / Coumadin dominated the anticoagulant market. These anticoagulants worked, but had serious drawbacks. Patients had to take these drugs twice a day, and required frequent doctor visits for blood work.

This blood work was important, since it’s a balancing act. Not enough anticoagulant in the blood, and patients risked stroke or other blood clot-related problems. Too much of the drug in their blood, and patients risked uncontrollable bleeding: the risk of bleeding to death from minor injuries.

Additionally, Warfarin and Coumadin worked by interfering with vitamin K, which the body uses in the blood clotting process. This means that patients using Warfarin had to deal with dietary restrictions to avoid accidentally eating enough Vitamin K to interfere with the blood thinner. Additionally, the patent on drugs in this generation of blood thinners expired, meaning they had a narrower profit margin for drug makers.

In 2011, Johnson & Johnson debuted Xarelto, the first in a new generation of blood thinners. These drugs were marketed as requiring only one dose per day. Xarelto worked differently from Warfarin and other older-generation anticoagulants. As such, Xarelto requires no dietary restrictions. Additionally, Xarelto’s marketing materials promoted that Xarelto as not requiring blood testing like Warfarin and older blood thinners do.

But new information has surfaced that Xarelto may not live up to marketing claims. The FDA has repeatedly pressured Johnson & Johnson’s claims that Xarelto does not require blood testing. Newer research has suggested that blood testing is just as necessary for newer drugs like Xarelto, as some patients metabolize the drug differently. This could mean that a person taking this blood thinner medication once a day might not have enough of the drug in their bodies to work, or too much, risking uncontrollable Xarelto bleeding.

Lastly, newer generation blood thinners like Xarelto may have a new risk. If a patient taking Warfarin had an uncontrollable bleeding incident, doctors could use one of the drug’s weaknesses in the patient’s favor. In this situation, very high doses of Vitamin K could actually shut Warfarin down. So if the drug was working “too well,” and a patient experienced uncontrollable bleeding, doctors could inject them with a very high dose of vitamin K, effectively letting the patient form blood clots to stop bleeding.

However, newer generations of blood thinners, including Xarelto, have no known reversal agent, potentially making them more dangerous. This has led to Xarelto bleeding lawsuits, as well as lawsuits against the makers of other similar new blood thinners.