Answering Your PAD Questions

Each day, people like you search online for answers to questions about peripheral artery disease (PAD) and XARELTO®, so we wanted to take this opportunity to answer some of them. Below, you’ll find answers to the questions people ask the most.


People with PAD have an increased risk for cardiovascular events like heart attack and stroke because PAD has similar risk factors and the same underlying cause as coronary artery disease (CAD), which affects the arteries that supply blood to the heart. In both conditions, plaque builds up in the arteries and can rupture, causing blood clots to form. These clots can cause pain and other symptoms in PAD, and heart attacks and strokes in CAD. It is common for people with PAD to also have CAD, so it’s important to ask your doctor about your risk for CAD. Read more about PAD and its risks.

XARELTO® works together with low-dose aspirin to help protect you from blood clots that may cause a heart attack, stroke, or cardiovascular death. Think of XARELTO® and aspirin like two members of the same team whose job it is to prevent blood clots from forming and growing. But they each play different positions—aspirin, an antiplatelet blood thinner, helps keep platelets (which are a type of blood cell) from sticking together, and XARELTO®, an anticoagulant blood thinner, helps slow down the blood's clotting process.

A study showed that adding XARELTO® to low-dose aspirin helps further reduce the risk of a heart attack, stroke, and cardiovascular death, compared to aspirin alone. Read more about XARELTO® and aspirin.

PAD is a progressive disease with risks that increase over time. Only your healthcare professional can decide how long you should take XARELTO®. Do not stop taking XARELTO® without talking to the healthcare professional who prescribes it for you. Stopping XARELTO® suddenly increases your risk for blood clots that may cause a heart attack or stroke.

While it’s great that you’re making healthy choices and feeling better, as long as plaque exists in your arteries, there is always a risk that it can rupture and cause blood clots to form. So, it’s important to continue taking XARELTO® as directed by your healthcare professional. Do not stop taking XARELTO® without talking to the healthcare professional who prescribes it for you. Stopping XARELTO® suddenly increases your risk for blood clots that may cause a heart attack or stroke.

If you miss a dose of XARELTO®, take your next 2.5 mg dose at your regularly scheduled time.

Aspirin has been a trusted medication to help reduce the risk of blood clots that may cause a heart attack or stroke. But we now know that aspirin alone may not be enough. While aspirin alone can help reduce your risk for these events, a large study of almost 40,000 people, including those with PAD or CAD, showed that even though more than half were taking aspirin, the number of heart attacks, strokes, and cardiovascular deaths more than doubled over a two-year period.* Read more about adding XARELTO® to your daily low-dose aspirin, and how it can help.

*According to data from the REACH Registry.


XARELTO® is a prescription blood thinner that, when taken with low-dose aspirin, helps reduce the risk of a sudden decrease in blood flow to the legs, major amputation, serious heart problems or stroke in people with peripheral artery disease (a condition where the blood flow to the legs is reduced) and includes people who have recently had a vascular intervention (a procedure to improve blood flow to the legs). Learn more.

XARELTO® lowers your blood’s ability to clot by selectively blocking one of the clotting factors found in your blood—an enzyme called Factor Xa (“10a”). Learn more.

Unlike warfarin (Coumadin®), XARELTO® has no known dietary restrictions. You can still enjoy eating leafy greens and other foods high in vitamin K without affecting how XARELTO® works.

XARELTO® has fewer drug interactions than older medicines like warfarin, but you should always tell your healthcare professional about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements—especially if you take ketoconazole, ritonavir, erythromycin, carbamazepine, phenytoin, rifampin, or St. John’s wort.

It’s also important to note that, as with all blood thinners, you have a higher risk of bleeding if you take XARELTO® with other medicines that also increase your risk of bleeding, such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), warfarin, any medicine that contains heparin, or clopidogrel.

Like all blood thinners, XARELTO® can cause bleeding, which can be serious, and in rare cases, can be life threatening. Be sure to take XARELTO® exactly as prescribed, and do not stop taking XARELTO® without talking to the healthcare professional who prescribes it for you. You should discuss all potential benefits and risks with your healthcare professional.

The cost of prescription medications can range widely depending on what kind of insurance you have and what types of support options may be available to you.

The list price of XARELTO® is $470 per month, but most patients pay between $0 and $47 per month.1,2

1Actual out-of-pocket costs may vary based on dosing, indication, site of care, insurance coverage, and your eligibility for support programs. Contact your insurance provider for more details on your individual plan. List price may vary based on dosing and indication. List price does not include induction doses, the cost of giving you a dose, or pharmacy fees.

2Approximately 75% of US patients pay between $0 and $47 per month. Out-of-pocket cost estimates are based on approved pharmacy claims, normalized to a 30-days’ supply, after application of insurance benefits. Costs do not include medical claims, induction doses, or starter kits. Note: This is based on information licensed from IQVIA: IQVIA Out of Pocket Cost (OPC Tool) for the period January 2019 – December 2019, reflecting estimates of real-world activity. All rights reserved.

Learn more about how much you can expect to pay for XARELTO®.

Savings are available through the Janssen CarePath Savings Program for XARELTO®. If you have commercial or private insurance and are being treated with XARELTO®—except if you are only taking XARELTO® 10 mg after a recent non-surgical hospitalization or because you have recently undergone knee or hip replacement surgery—you may be eligible for savings.

If you have government coverage, or no prescription coverage, Janssen CarePath can provide information about other resources that may be able to help with your out-of-pocket medication costs. Learn more about your savings options.

Do everything you can to fill your prescription before you run out. Skipping or stopping XARELTO® may increase your risk for blood clots that can cause a heart attack, stroke, or cardiovascular death. If you’ve been prescribed XARELTO®, you can set up monthly refill reminders when you register for Janssen CarePath, which offers support and educational resources for people taking XARELTO®.

If you need to have surgery or surgical dental procedures, be sure to tell your dentist, oral surgeon, or other healthcare professionals that you are taking XARELTO®. You should also talk to the healthcare professional who prescribed XARELTO® for you. Only they can tell you whether, and for how long, you may need to stop. If you do need to stop taking XARELTO®, it is typically stopped at least 24 hours before your procedure.

When starting XARELTO®, it takes 2–4 hours for it to reach its full blood-thinning effect, and it leaves your system more quickly than warfarin—typically in about 24 hours. Compared to warfarin, which can take 3–4 days to reach its full blood-thinning effect and up to 7 days to leave your system, XARELTO® may be a more convenient option for people who plan to have surgery or surgical dental procedures.

An agent to reverse the anti-factor Xa activity of XARELTO® is available in emergency situations under the direction of a healthcare provider. This agent may not always be necessary, since XARELTO® starts and stops working relatively quickly, which can help your healthcare professional manage your treatment if you plan to have surgery or surgical dental procedures. Do not stop taking XARELTO® without talking to the healthcare professional who prescribes it for you.

XARELTO® was developed together by Janssen and Bayer. They continue to develop XARELTO® to treat and help reduce the risk of blood clot–related events in different conditions.