Eliquis vs. Xarelto

See how Eliquis and Xarelto compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Both drugs are factor Xa inhibitors that lower stroke risk in atrial fibrillation and treat or prevent DVT and PE, but Eliquis is dosed twice daily while Xarelto is mostly once daily.

  • Xarelto requires three weeks of twice-daily dosing when starting VTE treatment, while Eliquis's higher starting dose lasts only seven days.

  • Both carry boxed warnings about stopping the drug early and about spinal or epidural bleeding risk with neuraxial procedures, and both have a specific reversal agent for bleeding emergencies.

Eliquis vs. Xarelto Drug Summary

Eliquis

Eliquis (apixaban) is a factor Xa inhibitor that lowers stroke risk in nonvalvular atrial fibrillation and treats or prevents blood clots like DVT and PE. It's taken as a tablet twice a day, every day, with no once-daily option for any indication.

Xarelto

Xarelto (rivaroxaban) is a factor Xa inhibitor used for the same core purposes: lowering stroke risk in atrial fibrillation and treating or preventing DVT and PE. Most doses are once daily, but treating a new clot starts with three weeks of twice-daily dosing first.

Eliquis vs. Xarelto Side Effects

Eliquis

Most common
epistaxis (up to 2.9%)
contusion (up to 1.8%)
hematuria (up to 1.7%)
menorrhagia (up to 1.4%)

Xarelto

Most common
major bleeding (3.6%/year)
gastrointestinal bleeding (2.0%/year)
pruritus (1% to 10%)
rash (1% to 10%)

Eliquis vs. Xarelto Dosage

Eliquis

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 10 mg twice daily Days 1-7
Maximum dose 2.5 mg twice daily If needed
Dose changes 2 increases As tolerated

Xarelto

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 15 mg twice daily Days 1-21
Maximum dose 10 mg once daily If needed
Dose changes 3 increases Every 21 days

Eliquis vs. Xarelto Indications

Eliquis

Eliquis is a factor Xa inhibitor prescribed to lower stroke risk in people with nonvalvular atrial fibrillation and to treat or prevent blood clots like DVT and PE. It's taken as a tablet twice a day, with a short seven-day higher dose when starting VTE treatment. It's also approved to treat VTE in children from birth onward.

  • Stroke and systemic embolism prevention in AFib

  • Treatment of DVT and PE

  • Reduction of recurrent DVT/PE after initial therapy

  • DVT prevention after hip or knee replacement surgery

  • Pediatric VTE treatment from birth onward

Xarelto

Xarelto is a factor Xa inhibitor used for the same core purposes: lowering stroke risk in atrial fibrillation and treating or preventing DVT and PE. Most maintenance doses are once daily, though VTE treatment starts with three weeks of twice-daily dosing. It's also approved to prevent clots in hospitalized medical patients at risk.

  • Stroke and systemic embolism prevention in AFib

  • Treatment of DVT and PE

  • Reduction of recurrent DVT/PE

  • DVT prevention after hip or knee replacement surgery

  • VTE prophylaxis in acutely ill medical inpatients

Eliquis vs. Xarelto Pros and Cons

Eliquis

Eliquis's FDA-labeled side effects are mostly localized bleeding events, like nosebleeds and bruising, rather than a single dominant risk. It has the broadest pediatric VTE approval among factor Xa inhibitors, covering treatment from birth onward. Steady twice-daily dosing is a strength for some patients and an extra step for others.

Pros

  • No multi-week loading phase needed for any indication

  • Approved for pediatric VTE treatment from birth onward

  • Short seven-day higher-dose start for VTE treatment

Cons

  • Must be taken twice daily for every indication, no once-daily option

  • Not approved for VTE prevention in hospitalized medical patients

  • No oral suspension option for patients who can't swallow tablets

Xarelto

Xarelto offers once-daily dosing for most long-term indications, which some patients find easier to stick with. It's also approved for preventing clots in hospitalized medical patients, a use Eliquis doesn't share. Its labeled bleeding rates are reported differently, with major bleeding tracked at 3.6% per year.

Pros

  • Once-daily dosing for AFib and long-term VTE prevention

  • Approved for VTE prevention in hospitalized medical patients

  • Oral suspension available for children who can't swallow tablets

Cons

  • Requires three weeks of twice-daily dosing to start VTE treatment

  • Major bleeding tracked at 3.6% per year in labeling

  • No pediatric VTE treatment approval like Eliquis has

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