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Xarelto vs Eliquis: What You Need to Know

Xarelto vs Eliquis: What You Need to Know

Doctors commonly prescribe the anticoagulant drugs Xarelto (rivaroxaban) and Eliquis (apixaban). These drugs are vital for preventing blood clots and lowering the risk of stroke in people with specific medical conditions. Both Xarelto and Eliquis are DOACs. They are better than blood thinners like warfarin. They are easier to take and have fewer dietary restrictions. To make good treatment decisions, patients and providers must know the key differences between these drugs.

This extensive guide will cover the similarities and differences. It will also cover the safety of Xarelto vs Eliquis. It will cover their drug interactions, monitoring needs, economic considerations, and patient considerations. People may choose the best medication for them by looking at these important factors. These factors will help them understand the drugs.

Similarities of Xarelto and Eliquis

Xarelto and Eliquis are both anticoagulant medications. They belong to the class of direct oral anticoagulants (DOACs).

Xarelto is an anticoagulant. It works by inhibiting Factor Xa, an enzyme in the blood clotting process. It is often used to prevent DVT and PE in patients having knee or hip replacement surgery. It reduces the risk of stroke in patients with nonvalvular atrial fibrillation. It also treats and stops DVT and PE from happening again.

Eliquis (apixaban) is another anticoagulant that also inhibits Factor Xa. It is prescribed for similar reasons as Xarelto. This includes preventing stroke and systemic embolism in patients with nonvalvular atrial fibrillation. It is also for treating and preventing the recurrence of DVT and PE.

Xarelto and Eliquis have some key differences. These are in dosing and metabolism. But, they share several similarities.

Mechanism of action

Xarelto (rivaroxaban) and Eliquis (apixaban) both work by inhibiting Factor Xa. This factor is key in the coagulation cascade. Factor Xa is central to blood clotting. It converts prothrombin into thrombin. Thrombin then turns fibrinogen into fibrin, which forms the mesh of a blood clot.

Xarelto and Eliquis inhibit Factor Xa. This stops the cascade and prevents clotting. They bind directly to Factor Xa and block its activity. This reduces thrombin generation and stops fibrin clot formation.

This mechanism differs from traditional anticoagulants like warfarin. Warfarin stops the liver from making vitamin K-dependent clotting factors (Factors II, VII, IX, and X). Warfarin requires regular monitoring and dose adjustments. This is to keep it working and reduce bleeding risk. In contrast, Xarelto and Eliquis offer more predictable anticoagulation with fixed doses.


Both Xarelto (rivaroxaban) and Eliquis (apixaban) are approved for similar uses. This shows that they are effective and safe. They prevent blood clots and treat conditions related to abnormal clotting. These indications include:

  1. Stroke Prevention in Nonvalvular Atrial Fibrillation (NVAF)

    • Both Xarelto and Eliquis reduce the risk of stroke and systemic embolism. They are for patients with nonvalvular atrial fibrillation (NVAF). NVAF is a common heart rhythm disorder. It is characterized by irregular and rapid heartbeats.

    • Atrial fibrillation raises the risk of blood clot formation in the heart chambers. Clots can form emboli that may travel to the brain and cause a stroke.

    • Xarelto and Eliquis offer effective anticoagulation therapy. They prevent stroke and systemic embolism in patients with NVAF. This reduces the risk of debilitating and potentially life-threatening events.

  2. Treatment and Prevention of Deep Vein Thrombosis (DVT)

    • Both medicines treat deep vein thrombosis (DVT). DVT is a condition of blood clots in the deep veins of the legs or pelvis.

    • DVT can lead to serious complications if untreated. These include pulmonary embolism (PE), where a blood clot travels to the lungs and blocks blood flow.

    • Xarelto and Eliquis treat acute DVT. They also prevent the recurrence of DVT in patients who finished initial anticoagulant therapy.

  3. Treatment and Prevention of Pulmonary Embolism (PE)

    • Xarelto and Eliquis are also indicated for the treatment of pulmonary embolism (PE), where blood clots block one or more arteries in the lungs.

    • PE is a life-threatening condition. It requires medical intervention right away. This is to prevent complications like respiratory failure and cardiac arrest.

    • Xarelto and Eliquis effectively treat acute PE. They also prevent PE from coming back in patients who’ve finished initial anticoagulant therapy.

  4. Prophylaxis of DVT in Patients Undergoing Hip or Knee Replacement Surgery

    • Xarelto and Eliquis are for preventing DVT. DVT is blood clot formation. It is for patients having hip or knee replacement surgery.

    • Surgery to replace a hip or knee raises the risk of DVT. This is due to immobility, surgical trauma, and changes in blood flow.

    • Xarelto and Eliquis reduce the risk of DVT and its complications. They are for patients having these surgeries.

Route of Administration

Both Xarelto and Eliquis are taken by mouth. They are more convenient than traditional anticoagulants like warfarin. Warfarin needs regular monitoring and dose adjustments. Xarelto and Eliquis have fixed doses. This simplifies treatment for patients.

Differences Between Xarelto and Eliquis

Before we talk about how often you need to take these medicines, let’s remember they both help stop blood clots. But Xarelto and Eliquis have some differences. One is how often you take them.

Dosage Frequency

Doctors usually recommend taking Xarelto (rivaroxaban) once a day. They typically prescribe Eliquis (apixaban) twice daily. This difference in dosing frequency may have implications for patient adherence and convenience. Patients taking Xarelto may find it easier to remember their medication schedule. They only need to take one dose per day. This change could improve their treatment adherence.


Xarelto undergoes hepatic metabolism. It is mainly via the cytochrome P450 enzyme system, with a small renal elimination part. Changes in metabolism may affect drug interactions. They can also affect dose adjustments, especially in patients with liver problems.


The half-life of a medication refers to the time it takes for half of the drug to be eliminated from the body. Xarelto (rivaroxaban) and Eliquis (apixaban) have notable differences. They are in their half-lives. Xarelto’s half-life is about 5 to 9 hours in healthy people. Eliquis’s half-life is a shorter 12 hours.

This discrepancy in half-life has significant implications for dosing intervals and the potential for drug accumulation in the body, especially in patients with renal impairment. A shorter half-life, such as that of Eliquis, means that the drug is cleared from the body more rapidly compared to Xarelto.

Renal Clearance

The way the body gets rid of drugs, especially ones like Xarelto and Eliquis, which are mostly removed through the kidneys, is called renal clearance. Xarelto is mostly cleared through the kidneys, with about 66% of it leaving the body unchanged in urine. Eliquis, however, relies less on the kidneys, with only about 27% left unchanged in urine. This means in people with kidney problems, Xarelto might stay in the body longer, which could cause more side effects like bleeding. But Eliquis might be safer for these people because it doesn’t rely as much on the kidneys

Xarelto vs Eliquis Side Effects

Safety is critical when evaluating drugs like Xarelto (rivaroxaban) and Eliquis (apixaban). This is especially true for their side effects and risks. Patients and providers must understand the side effects of these drugs and compare their safety.

Common side effects of Xarelto

It may cause several common side effects, including:

  • Bleeding: This is the most significant concern associated with Xarelto. It can manifest as nosebleeds, bruising, or prolonged bleeding from minor cuts or injuries. Severe bleeding, though rare, can be life-threatening and require urgent medical attention.

  • Gastrointestinal discomfort: It may cause stomach pain, indigestion, or diarrhea in some individuals.

  • Headache: Headaches are a relatively common side effect of medication treatment.

  • Dizziness: Some patients may experience dizziness or lightheadedness while taking Xarelto.

Common side effects of Eliquis

Eliquis shares similar side effects with Xarelto, including:

  • Bleeding: Like Xarelto, Eliquis carries a risk of bleeding, which is the most significant concern associated with its use.

  • Gastrointestinal symptoms: Eliquis may cause stomach upset, indigestion, or diarrhea in some patients.

  • Headache: Headaches are reported as a common side effect of Eliquis treatment.

  • Fatigue: Some individuals may experience fatigue or tiredness while taking Eliquis.

Comparison of safety profiles, including major bleeding risks

  • Both Xarelto and Eliquis have a risk of major bleeding. This includes gastrointestinal bleeding, intracranial hemorrhage, and other serious bleeding.

  • Clinical studies have shown that the risk of major bleeding is similar for Xarelto and Eliquis. There are no big differences between the two medications.

  • But, patient factors like age, kidney function, and use of other drugs, may also affect the bleeding risk with each anticoagulant.

  • Healthcare providers must assess each patient’s risk factors. They must weigh the benefits of anticoagulant therapy against the risks of bleeding before prescribing Xarelto or Eliquis.

  • You need to monitor patients regularly. You also need to educate them about signs of bleeding. These steps are key for safe anticoagulant therapy with Xarelto and Eliquis.

Monitoring and Reversal Agents

Monitoring and the availability of reversal agents are crucial. They are key to managing anticoagulant therapy. This is with drugs like Xarelto and Eliquis. Here’s a breakdown of the monitoring requirements and available reversal agents for both medications:

Monitoring Requirements for Xarelto

  • Unlike warfarin, a traditional anticoagulant, Xarelto typically does not need routine blood level monitoring. It also needs fewer dose adjustments. This is because Xarelto has predictable pharmacokinetics and a fixed dosing regimen.

  • However, providers may monitor certain parameters, like renal and liver function, and signs of bleeding, during Xarelto therapy. They do this to check its safety and efficacy.

  • Also, patients taking Xarelto should be taught about the signs and symptoms of bleeding. They should be told to get medical help right away if they have any unusual bleeding or bruising.

Monitoring Requirements for Eliquis

  • Like Xarelto, Eliquis does not need routine blood level monitoring. Also, it does not need frequent dose adjustments. This is because Eliquis has predictable pharmacokinetics and a fixed dosing regimen.

  • However, providers may consider monitoring the kidneys, liver, and bleeding. They should do this periodically during Eliquis therapy. This is to ensure its safety and efficacy.

  • Patients should also learn the signs and symptoms of bleeding. They should seek prompt medical attention if they have any concerning symptoms while taking Eliquis.

Available Reversal Agents for Both Medications

  • Reversal agents, also called antidotes, are drugs. They are used to reverse the anticoagulant effects of Xarelto and Eliquis. This is done in case of bleeding or emergency surgery.

  • For Xarelto, the reversal agent andexanet alfa (Andexxa) is available. Andexanet alfa works by binding to Xarelto and stopping its anticoagulant effects. This allows normal blood clotting to resume.

  • Similarly, Eliquis has a reversal agent called idarucizumab (Praxbind). Idarucizumab rapidly reverses the blood-thinning effects of Eliquis. It does this by reversing its anticoagulant effects.

  • These reversal agents are valuable tools. They can manage bleeding emergencies in patients taking Xarelto or Eliquis. They help restore normal blood clotting and cut the risk of severe bleeding.

Xarelto vs Eliquis Costs and Insurance Coverage

The cost of Xarelto can vary based on factors such as dosage strength, quantity prescribed, and pharmacy pricing. Patients without insurance or with high copays may struggle to afford Xarelto. Some drug companies offer patient assistance. Pharmacy partners from Canada, like USA Script Helpers, may offer low prices for Xarelto. This ensures patients can get the drug at the lowest cost.

Similar to Xarelto, the cost of Eliquis can fluctuate depending on dosage, quantity, and pharmacy pricing. Patients may encounter affordability issues if they lack insurance coverage or have high copays. These programs help eligible individuals cut the cost of Eliquis. They include patient assistance programs, copay cards, and pharmacy discounts. Pharmacy partners, like USA Script Helpers, may also offer the lowest prices for Eliquis. This ensures affordability and access for patients in need.

Insurance plans commonly cover both Xarelto and Eliquis. This includes Medicare and private insurance. Insurance may cover these drugs. The coverage may vary by plan, formulary, and patient benefits. Patients should check their insurance and formulary. They should see if it covers Xarelto or Eliquis and any out-of-pocket costs. Healthcare providers can help patients with insurance issues. They can also help them explore other treatment options if needed.

Choosing Wisely Between Xarelto and Eliquis

Choosing between Xarelto and Eliquis requires thought. You must consider dosing, metabolism, kidneys, cost, and insurance. Both drugs are good anticoagulants with similar uses. However, their differences may affect outcomes and patient satisfaction.

Patients should work closely with their healthcare providers. They will weigh the pros and cons of each medication based on their needs and preferences. By staying informed and proactive, patients can make empowered decisions. They can ensure the best management of their condition.

Remember, whether it’s Xarelto or Eliquis, the most important aspect is finding the right fit for you. Prioritize communication and informed decision-making. Then, you can start a treatment journey that values both effectiveness and safety.

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