The blood thinner warfarin was approved by the Federal Drug Administration in 1954 to help lower the risk of blood clots leading to stroke for the more than 2 million Americans who have an abnormal heart rhythm known as atrial fibrillation. For many years, warfarin (Coumadin) was the only medication available.

Atrial fibrillation disrupts the flow of blood through the heart, allowing it to pool and clot, and then travel to the brain where it causes a stroke.

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In 2011, the FDA approved Johnson & Johnson’s blood thinner Xarelto to treat atrial fibrillation. A clinical trial with more than 14,000 patients found Xarelto was similar to warfarin in the ability to prevent strokes. Here are some differences between the two popular blood thinners.

1. They work differently. Warfarin works by making the blood less likely to clot by blocking the body's capacity to recycle vitamin K, which it uses to form clots. With less vitamin K in circulation, blood takes longer to clot, but patients need constant testing to determine dosage. Xarelto doesn't affect vitamin K, and constant monitoring isn't needed.

2. Dosage. For stroke risk reduction, the usual dose of Xarelto is 20 milligrams once a day, taken with the evening meal, according to WebMD. The optimal dosage of Warfarin varies from person to person and can depend on diet, age and other medications. “The dosing is delicate," said WebMD. "Give too much, and the risk of bleeding rises, sometimes dangerously. Give too little, and the stroke risk remains.”

3. Price. Xarelto is more expensive for those without insurance. Goodrx.com shows the lowest available price for 30 20mg tablets of Xarelto is $325.95 while the lowest available price for 30 5mg tablets of generic Warfarin is $4. However, since Xarelto is typically covered by insurance, for those with coverage the cost differences would be minimal. In some cases, the out-of-pocket price for Xarelto is lower than Warfarin.

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4. Bleeding. Warfarin carries a risk of brain hemorrhage, which is uncommon but deadly. But a patient takes too much warfarin, the side effects can be countered by giving the patient Vitamin K. According to WebMD, there’s no antidote for overshooting with Xarelto, unless it’s fresh plasma. Although significant bleeding events occur less frequently when taking Xarelto than with warfarin, they can occur. Fortunately the serum half-life of Xarelto is relatively short -- five to nine hours -- so its effect will vanish within about 24 hours.

5. Dietary concerns. Patients on warfarin must undergo blood tests at least monthly and watch their intake of Vitamin K, a nutrient that can lessen the effectiveness of warfarin and can be found in leafy green vegetables such as spinach, chard and kale. No dietary issues are present with Xarelto.

6. Hips and knees. In studies on hip and knee replacement patients, those taking Xarelto were much less likely than those on other anti-clot therapies, including warfarin, to have clot problems, according to WebMD.

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