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
Xarelto
Eliquis vs. Xarelto Dosage
Eliquis
Xarelto
| 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 |
| 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
| 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
| 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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