Xarelto vs Eliquis: How Do They Compare?

January 24, 2025

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Cardiovascular

When it comes to managing and preventing blood clots, two of the most commonly prescribed medications are Xarelto (rivaroxaban) and Eliquis (apixaban). Both belong to a class of drugs known as direct oral anticoagulants (DOACs), which offer an alternative to traditional blood thinners like warfarin. But how do Xarelto and Eliquis compare in terms of effectiveness, safety, and cost? Let’s break it down.

Quick Facts

Feature	Xarelto (Rivaroxaban)	Eliquis (Apixaban)
Approval Year	2011	2012
Dosage	Once daily	Twice daily
Main Uses	Stroke prevention, DVT/PE treatment	Stroke prevention, DVT/PE treatment
Cost	~$550/month (brand name)	~$550/month (brand name)
Generic Available?	No (Patent until 2039)	FDA-approved but not available

What Are Xarelto and Eliquis?

Xarelto, developed by Bayer, is typically taken as a once-daily medication. Eliquis, created by Bristol-Myers Squibb and Pfizer, is typically taken twice-daily. Both are prescribed to treat or prevent blood clots and are approved for the following conditions:

Reduce the risk of stroke and blood clots in people with nonvalvular atrial fibrillation (AFib).
Treat and prevent deep vein thrombosis (DVT) and pulmonary embolism (PE).
Prevent blood clots in adults undergoing hip or knee replacement surgery.

Additionally, Xarelto is also approved to:

Prevent major cardiovascular events in individuals with coronary artery disease (CAD) or peripheral artery disease (PAD) (when combined with aspirin).

Effectiveness: Head-to-Head Comparison

Stroke and Blood Clot Prevention in AFib

A large retrospective study consisting of 581, 451 patients with atrial fibrillation (AFib) by Ray et al., 2021 [1] comparing Xarelto and Eliquis found Eliquis to be more effective in reducing the risk of stroke or systemic embolism in patients with AFib. Specifically, Eliquis patients 65 years and older had lower rates of stroke/systemic embolism and better overall outcomes compared to those treated with Xarelto.

DVT and PE Treatment

Both Xarelto and Eliquis are effective for treating and preventing DVT and PE, but some studies suggest Eliquis might have a slight edge in safety (fewer bleeding events). However, the choice often depends on individual patient factors.

Safety: Bleeding Risks and Side Effects

Bleeding Risks

The most significant risk associated with anticoagulants is bleeding. Research shows that Eliquis generally has a lower risk of major bleeding compared to Xarelto.

In the study by Ray et al., 2021 [1], Eliquis showed lower rates of hemorrhagic effects (5.9 vs 7.5 per 1000 person-years), fatal extracranial bleeding (1.0 vs 1.4 per 1000 person-years) and intracranial hemorrhage.

Common Side Effects

Both medications share some common side effects, including:

Bruising
Bleeding
Gastrointestinal bleeding
Nausea

If you experience severe bleeding, dizziness, or symptoms like tingling in the legs, seek immediate medical attention.

Dosage and Administration

Condition	Xarelto Dosage	Eliquis Dosage
Stroke prevention in AFib	20 mg once daily	5 mg twice daily
DVT/PE treatment	15 mg twice daily for 21 days, then 20 mg once daily	10 mg twice daily for 7 days, then 5 mg twice daily
Post-surgery clot prevention	10 mg once daily	2.5 mg twice daily

Xarelto’s once-daily dosing may be more convenient for some patients, while Eliquis’ twice-daily dosing provides more consistent blood levels.

Cost Comparison

The cost of these medications can be a deciding factor for many patients:

Xarelto: ~$550 per month for the brand-name drug. No generic version is currently available (patent until 2039).
Eliquis: ~$550 per month for the brand-name drug. A generic version has been FDA-approved but is not commercially available due to patent protections (until 2026).

For patients with insurance, copays and prior authorization requirements vary widely. For those without insurance, patient assistance programs may help reduce costs.

Through our network, both uninsured and insured patients can often benefit from low cash-pay prices that may be less than traditional copays. Use our Medications Search tool to compare prices on hundreds of brand and generic medications to see how much you can save.

Special Considerations

Kidney Function

Eliquis is often preferred for patients with moderate to severe kidney disease due to its lower reliance on kidney function for elimination.
Xarelto may require dose adjustments in patients with impaired kidney function.

Older Adults

Older adults taking Xarelto may have a higher risk of bleeding compared to those on Eliquis. This makes Eliquis a safer option for many older individuals.

Children

Xarelto is approved for use in children for certain conditions, whereas Eliquis is not FDA-approved for pediatric use.

Transitioning Between Medications

Switching from one anticoagulant to another is possible but should always be done under the supervision of a healthcare provider. Improper transitions can increase the risk of bleeding or clotting.

Which Is Better, Xarelto or Eliquis?

Both Xarelto and Eliquis are effective anticoagulants, but they have distinct differences in dosing, safety profiles, and patient suitability:

Xarelto may be recommended by your prescriber if you prefer once-daily dosing or have additional conditions like coronary artery disease or PAD.
Eliquis may be recommended by your prescriber if you’re at higher risk of bleeding, have kidney issues, or need a safer option as an older adult.

Ultimately, the decision should be made in consultation with your healthcare provider, who can evaluate your medical history, lifestyle, and risk factors.

Actionable Takeaways

Talk to your doctor about your medical history and preferences when deciding between Xarelto and Eliquis.
Monitor for side effects like unusual bleeding or bruising, and report them immediately.
Adhere to your prescribed dosage to minimize risks and ensure effectiveness.
Explore cost-saving options like those available through CanAmerica Plus

References

[1]: Ray, W. A., Chung, C. P., Stein, C. M., Smalley, W., Zimmerman, E., Dupont, W. D., Hung, A. M., Daugherty, J. R., Dickson, A., & Murray, K. T. (2021). Association of Rivaroxaban vs Apixaban With Major Ischemic or Hemorrhagic Events in Patients With Atrial Fibrillation. JAMA, 326(23), 2395–2404. https://doi.org/10.1001/jama.2021.21222

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider for diagnosis and treatment. The information provided is current as of January 2025, but medical knowledge evolves rapidly. Verify any critical information with your healthcare provider.