Eliquis (apixaban) and Xarelto (rivaroxaban) are two brand-name medications known as direct oral anticoagulants (DOACs) that treat various blood clotting disorders. Anticoagulants such as Eliquis and Xarelto help prevent blood clots from forming that may cause stroke, heart attack, pulmonary embolisms, and more. The anticoagulants work by blocking Factor Xa (FXa), a natural thrombin-producing agent that helps form blood clots.
When we have a cut that bleeds, a blood clot forms to keep the penetrated site clean and protected so the injury can heal. This is how blood clotting should occur: blood flows normally while specific components in the blood prevent clotting from happening until needed. Typically, when a cut occurs, the blood vessel narrows, platelets travel to the injury site, and a platelet plug forms to make a blood clot.
However, some people form unnecessary blood clots. When a blood clot occurs in the brain, lungs, or heart, the result may be a life-threatening stroke, pulmonary embolism, or heart attack.
For over 50 years, a blood thinning medication commonly known as Coumadin helped prevent unnecessary blood clots. However, serious bleeding chances required regular blood tests to determine proper dosing.
Now, those using Xarelto or Eliquis to manage blood clotting disorders don’t require frequent blood tests. Moreover, these newer anticoagulants are widely used, especially among Medicare patients and for approximately one-third of hospital patients.
Xarelto and Eliquis, while similar, do have some differences. Understanding their similarities and differences can help patients confidently discuss their anticoagulant needs with a healthcare provider.
- Both Eliquis and Xarelto are FDA approved for prescription use, but neither is marketed in a generic form (though a generic form of Eliquis is approved, it is unavailable until 2026).
- Both of the DOAC medications can be taken in tablet form, but dosages vary depending on need.
Both medications are used to:
- lower the risk of blood clots and stroke for people with nonvalvular heart valve fibrillation,
- reduce stroke and embolism risks in patients with nonvalvular atrial fibrillation,
- lower risk of deep vein blood clots (deep vein thrombosis DVT) following hip or knee replacement surgery,
- treat DVT and Pulmonary Embolism (PE) following specific surgery,
- lower the risk of repeated DVT and PE.
In addition, Xarelto is approved for these uses:
- prevent blood clots in children at least 2 years old who have congenital heart disease and have had a surgical procedure called Fontan Procedure,
- lower the risk of repeat DVT or PE in children of all ages,
- prevent venous thromboembolism (VTE) and VTE-related death,
- Xarelto may be prescribed during hospitalization and after discharge in adults at risk for complications due to restricted mobility and other risk factors (Note: Xarelto should not be prescribed to patients who are at high risk for bleeding),
- prevent blood clots in people who are at high risk of blood clots after discharge,
- Xarelto is often used with aspirin to lower the risk of major cardiovascular events such as death, heart attack, and stroke in patients with chronic coronary artery disease (CAD) or peripheral artery disease (PAD),
- to lower risk of major complications due to blood clots for people with PAD when combined with aspirin
Dosing and Treatment Depends on Needs
- Xarelto dosing recommendations may be lower if patients have kidney problems,
- Eliquis may be taken with or without food,
- Xarelto should be taken with food in cases of atrial fibrillation or to treat DVT or PE,
- Eliquis is available in pill form only; Xarelto is available in both pill and liquid forms
Certain medications may raise or lower the amount of Eliquis or Xarelto in your body. If the level of either anticoagulant is too high, dangerous bleeding can occur. If levels are too low, the medication may not work well, which may cause blood clots. Because drug interactions can occur with Eliquis and Xarelto, it’s recommended that you provide your current medication list to both your healthcare provider and pharmacist who can double-check for interactions and provide you with recommendations.
Taking one of the following medications along with Eliquis or Xarelto may raise the risk of bleeding or raise the risk of clotting, but may be deemed necessary. Your healthcare
provider can determine benefits and risks.
|Medications that may raise bleeding risk||Medications that may raise clotting risk|
|Aspirin||St. John’s Wort for depression, anxiety, or insomnia|
|Non-steroidal anti-inflammatory medications (NSAIDs)||Rifampin (ansamycin antibiotic used to treat several types of bacterial infections)|
|Clopidogrel (Plavix) antiplatelet medication||Carbamazepine (Tegretol) anticonvulsant medication used primarily in the treatment of epilepsy and neuropathic pain|
|Heparin anticoagulant medication||Phenytoin (Dilantin, Phenytek) anti-epileptic drug, also called an anticonvulsant|
|Antidepressants, like selective serotonin reuptake inhibitors (SSRIs)|
Eliquis and Xarelto can build up in the body, leading to bleeding if you take certain other medications. These medications include ketoconazole, itraconazole (Sporanox), and ritonavir (Norvir).
Note that the information provided here may not include all potential interactions with Eliquis and Xarelto. Therefore, check with your healthcare provider or pharmacist before starting any new medication or herbal product.
Overall, Xarelto and Eliquis demonstrate safety, efficacy, and ease of use. This makes them “agents of choice” for managing many coagulation disorders. Though safe, there are known side-effects to watch for:
- Bleeding and bruising are most common side-effects: watch for nosebleeds,
blood in urine, and bleeding gums
- rare but life-threatening bleeding is possible, but uncommon,
- Eliquis may cause fatigue, energy loss, weakness, nausea, and shortness of breath
|Pain in abdomen, back, arms, or legs||x|
|Mild allergic reaction||x||x*|
*Though not reported in clinical trials, allergic reaction has been reported and is possible when taking Xarelto.
Mild side-effects are usually temporary. If side-effects last longer than a few days to weeks, become severe, or bother you, talk with your healthcare provider or pharmacist.
More serious side-effects that may occur may require that you call your doctor immediately; if side-effects appear life threatening, call 911 immediately.
|Increased risk of clots if treatment stopped early||x||x|
|Mental health effects, like anxiety and depression||x|
|Risk of blood clots in spine with spinal procedures||x||x|
|Serious bleeding, such as gastrointestinal bleeding||x||x|
|Severe allergic reaction||x||x|
Generally, neither medication is recommended over the other. However, there are instances when either Xarelto or Eliquis may be considered a better choice by you/your healthcare provider based on personal preferences or medical history:
- Eliquis may be your better choice if you have kidney problems,
- Xarelto may be a better choice for patients who forget to take a second daily pill
Studies do point to a higher efficacy for older patients who use Eliquis: this reflects study results that determined Xarelto leads to higher chances of bleeding for older populations.