Eliquis vs. Xarelto: Which Is Better & Safer?

Your body has its own repair mechanism every time you get injured. For instance, if you cut yourself, a clot forms to stop you from bleeding and losing too much blood. While part of the natural healing process, blood clots formed in places they shouldn’t be — such as the heart for people diagnosed with atrial fibrillation — can be fatal.

For this reason, blood thinners are medically necessary to prevent clots from forming. Doctors and patients often compare Eliquis vs. Xarelto when choosing the best medication for clot-related problems. While they belong to the same class of drugs and serve the same purpose, they differ in dosing, cost, and safety profile. Learn more about these two most widely prescribed blood thinners and determine which is safer, more affordable, and causes a lower risk of bleeding.

Are Eliquis and Xarelto the Same?

This table summarizes the similarities and differences between Eliquis and Xarelto.

What is Eliquis?

Eliquis belongs to a class of drugs called anticoagulants or blood thinners. It contains the active substance apixaban. Doctors prescribe it to prevent and treat blood clots and minimize the complications in many conditions, such as:

• • Nonvalvular atrial fibrillation (AFib): Eliquis reduces the risk of stroke and systemic embolism in people diagnosed with AFib.
  • Pulmonary embolism (PE) and deep vein thrombosis (DVT): It’s used as a treatment and a prevention measure to avoid disease relapse.
  • After hip or knee replacement surgery: Doctors recommend it to prevent blood clots from forming during recovery.

Eliquis blocks a specific clotting protein in the blood known as Factor Xa (FXa). Why do doctors prefer Eliquis over other anticoagulants? First, it doesn’t require routine blood tests. Second, it also has a lower chance of causing bleeding, affecting 1% of users in clinical trials.

If prescribed Eliquis, follow your doctor’s instructions to avoid interactions, especially if you’re taking multiple medications at a time.

What Is Xarelto?

The drug classification of Xarelto is a blood thinner. It contains the active substance rivaroxaban and is widely prescribed to prevent and treat severe blood clots.

Like Eliquis, Xarelto is an FXa inhibitor. It restricts the activity of FXa, a protein involved in the formation of clots. It treats nearly all the conditions Eliquis is prescribed for, such as AFib, DVT, and PE. It can also mitigate the risk of heart complications in people with coronary artery disease (CAD) or peripheral artery disease (PAD).

Why is Xarelto preferred over Eliquis? One reason is its unique FDA approvals. It can be used for preventing blood clots in acutely ill medical patients or minimizing heart-related complications in people with PAD or CAD — a feature that Eliquis isn’t approved for.

While useful, Xarelto has a higher chance of bleeding than Eliquis. In clinical trials, at least 5% of patients treated with it experienced this adverse reaction. If prescribed Xarelto, you should discuss bleeding risks with your healthcare provider.

Mechanism of Action

Because they belong to the same class of drugs, Eliquis and Xarelto have similar basic mechanisms of action. They both block FXa, whether already involved in a clot or floating freely in the blood. When taken orally, the formation of clots slows down, lowering the risk of stroke, DVT, PE, and clot-related health complications in high-risk patients.

Eliquis vs. Xarelto: Dosage and Administration 

Eliquis has a different dosing schedule from Xarelto. You should consider the dosing schedule if you’re looking for a blood thinner that can easily fit into your lifestyle and treatment regimen.

Eliquis Dose

Eliquis comes in three dosage forms and strengths:

• • 2.5 mg and 5 mg tablets
  • 0.5 mg tablet for oral suspension
  • 0.15 mg in a yellow opaque capsule for oral suspension

How often is Eliquis taken? Eliquis is typically taken once or twice daily, depending on the condition.

You can take Eliquis with or without food.

Xarelto Dose

Xarelto comes in two forms and strengths:

• • 2.5 mg, 10 mg, 15 mg, and 20 mg tablets
  • 1 mg/mL reconstituted for oral suspension

Like Eliquis, the recommended dose depends on the condition.

You can ask your doctor about Eliquis vs. Xarelto dosing differences to better understand which is more convenient for you to use. Some may prefer the simplicity of once-daily Xarelto, while others may opt for Eliquis for a lower risk of adverse reactions.

Eliquis vs. Xarelto Side Effects and Risks

In clinical studies regulated by the FDA, more than 1% of Eliquis patients reported bleeding. Meanwhile, at least 10% of pediatric patients experienced vomiting, headache, and excessive menstrual bleeding.

For Xarelto, more than 5% of adult patients reported bleeding, while over 10% of children users experienced vomiting, cough, and gastroenteritis.

Apart from these common adverse reactions, both blood thinners may cause serious side effects that include:

• • Fatal bleeding
  • Increased risk of blood clots, especially when treatment is prematurely discontinued
  • Spinal or epidural hematoma for patients who are undergoing spinal puncture or receiving neuraxial anesthesia
  • Increased risk of blood clots in people diagnosed with triple positive antiphospholipid syndrome (APS)
  • Possible death and bleeding in patients with prosthetic heart valves

If you experience bruising with Xarelto or Eliquis, inform your doctor immediately so they can check your condition. Bruises are a common side effect of blood thinners. However, if they become unusually painful and hard or are accompanied by internal bleeding, seeking medical attention is the best course of action.

Is it Safe for Pregnant Women?

Xarelto may elevate the risk of pregnancy-related hemorrhage or early delivery, so it’s only prescribed if the benefits can outweigh these risks. In contrast, Eliquis is not recommended for expectant mothers at all because of the lack of safety data. Based on animal studies, no adverse developmental effects were associated with using Eliquis, but it hasn’t been proven in humans yet.

So, which has fewer side effects, Xarelto or Eliquis? In general, Eliquis causes fewer and less serious side effects than Xarelto.

Let your doctor know if you experience unusual or severe symptoms so they can monitor your condition.

Effectiveness and Safety

Many ask, “Which blood thinner is safer, Eliquis or Xarelto?” Here’s how they generally compare in terms of safety and effectiveness based on different studies.

Eliquis vs. Xarelto Bleeding Risk

Based on clinical trials, bleeding affects over 1% of Eliquis users, whereas it affects more than 5% of patients on Xarelto. Eliquis is considered a safer medication as it has a lower chance of causing bleeding.

Eliquis vs. Xarelto for AFib

In a study published in JAMA Network, experts looked at over 580,000 patients aged 65 and older with AFib. Between 2013 and 2018, these patients began treatment — some were taking Eliquis, others Xarelto. They were followed for about four years.

The key findings revealed that patients who took Xarelto had a higher risk of:

• • Fatal bleeding
  • Stroke or blood clots
  • Serious bleeding in the brain or other organs
  • Higher overall death rates

Meanwhile, Eliquis was associated with fewer serious complications. Considering these results, Eliquis is safer and more preferable than Xarelto when preventing strokes in patients with AFib.

Eliquis vs. Xarelto for DVT

In a 2019 study published in the National Library of Medicine, experts examined insurance data from 38,630 VTE patients in the U.S. They found that those who took Eliquis had fewer repeat blood clots than those on Xarelto. Not only that, there were also fewer cases of significant bleeding with Eliquis, even for people with cancer, kidney disease, or serious PE.

Xarelto vs. Eliquis in Older Adults

The Beers Criteria — developed by the  American Geriatric Society (AGS) — contains a list of all medications that older people shouldn’t use or take because they can be dangerous.

In 2023, the AGS updated this list, changing Xarelto — previously labeled as “use with caution” — to “avoid” for long-term treatment of AFib and VTE.

The change was implemented after research showed that rivaroxaban causes more serious bleeding — especially in the stomach and intestines —  compared to other blood thinners, like Eliquis and Pradaxa (dabigatran). Based on this update, Eliquis is safer for older adults to use.

Eliquis vs. Xarelto for Kidney Function

Another study compared how effective and safe oral blood thinners are — including Eliquis and Xarelto — and their effects on kidney function in patients with atrial fibrillation.

Researchers found that Eliquis decreased the risk of stroke, major bleeding, and death. Xarelto provided similar benefits  — though not as strongly as Eliquis. These outcomes show that Eliquis works better than Xarelto at preventing complications in people with reduced kidney function.

So, which blood thinner is safer, Eliquis or Xarelto? Based on these separate studies, Eliquis is generally safer than Xarelto because it carries a lower risk of bleeding while offering protection against blood clots and stroke.

Cost of Eliquis vs. Xarelto

Both Eliquis and Xarelto are brand-name medications. Neither drug has an FDA-approved generic version as of now, making them relatively costly for people without insurance. For those who may need to take blood thinners for years, affordability can be a massive hindrance to ensuring consistent treatment.

So, which is more expensive, Xarelto or Eliquis? The average cost of Eliquis in the U.S. is $728, while Xarelto’s price racks up to $1,128. Although Eliquis is slightly more affordable, the cost can still be steep if you pay out of pocket. Pharmacy discount programs can lower the prices, but they often come with some requirements you must meet.

Another saving option is to purchase your medications from Canadian online prescription platforms like Buy Canadian Insulin, where drug prices are more affordable.

From $728, you can get 60 tablets of either 2.5 mg or 5 mg Eliquis for only $157. For Xarelto, you can purchase 100 tablets of 2.5 mg for only $199 instead of $1,128. Purchasing from Buy Canadian Insulin saves you up to 90% on medications.

If you’re seeking a cheaper alternative to Xarelto, consider warfarin, but take note that it requires routine blood testing. Other Xarelto alternatives are Pradaxa (dabigatran) and Savaysa (edoxaban).

Switching From Xarelto to Eliquis or Vice Versa

Typical reasons for switching between Xarelto and Eliquis are cost, hard-to-manage or severe side effects, limitations on insurance coverage, and convenience. You might find the often once-daily dosing of Xarelto easier to adhere to and suited for your lifestyle, while others may feel more stable on Eliquis, which is taken twice daily.

Only switch blood thinners under your doctor’s supervision. Since there’s no direct milligram-to-milligram Xarelto to Eliquis dose conversion or vice versa, talk to your healthcare provider about dose and timing adjustments. When starting treatment, ensure that you follow their instructions on when, how much, and how frequently you should take your tablets to prevent missed doses or potential complications.

Always consult your doctor before making any changes to your treatment plan.

Eliquis vs. Xarelto: Which Is a Better Blood Thinner? 

Eliquis and Xarelto are effective anticoagulants to prevent strokes and treat blood clots in many conditions. Each has its pros and cons. For instance, in studies, Eliquis has a lower risk of bleeding, though its twice-daily dosing may be less convenient for some users. In contrast, Xarelto is taken once daily, making it easier to remember each dose. However, it may come with a slightly higher bleeding risk.

In choosing the ideal treatment for you, your doctor will assess your overall health, factoring in your age, kidney function, insurance coverage, and preferred medication timing schedule. Ultimately, the best option is one that fits your health profile with fewer risks.

Frequently Asked Questions

Original Publish Date: 12/1/2022 – Updated 6/06/2025