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Blood thinners – also known as antiplatelet drugs or anticoagulants – are medications used to stop the formation of blood clots. They are often prescribed to prevent issues such as stroke or blockages and reduce the risk of heart attacks. Two commonly used direct oral anticoagulants are Xarelto (rivaroxaban) and Eliquis (apixaban). Both of these medications are used to reduce blood clots and stroke risk – particularly for patients with conditions like atrial fibrillation (AFib) and DVT/PE. This article will compare how these medications work and how they are different. It will also include what patients should look out for.
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Studies have been done on both of these medications. The ROCKET-AF for Xarelto studied 14,264 patients with AFib – a heart rhythm problem that increases stroke risk. These patients were randomly assigned to take either rivaroxaban (20 mg daily) or warfarin. The goal was to see if rivaroxaban worked at least as well as warfarin at preventing stroke or blood clots. Results found that rivaroxaban was just as effective as warfarin for preventing stroke or systemic embolism. However, serious brain-related bleeding (intracranial hemorrhage) and fatal bleeding were less common with rivaroxaban.
The ARISTOTLE study for Eliquis was also done. This study also compared the medication to warfarin in patients with atrial fibrillation. The results showed that Eliquis was safer and more effective in several ways. Patients taking Eliquis experienced 31% fewer major bleeding events than those on warfarin. This medication reduced major or clinically relevant bleeding by 32% and overall bleeding by 29%. Intracranial hemorrhage was also 58% lower with Eliquis and there were fewer fatal bleeding cases with Eliquis.
Another study comparing apixaban to rivaroxaban for use in nonvalvular AFib patients explained that apixaban had a lower risk of gastrointestinal bleeding and stroke/systemic embolism associated with its use compared to rivaroxaban. This study also found that both products had similar effectiveness. Overall efficacy is considered comparable by most guidelines.
Xarelto and Eliquis are similar. There are still some distinct differences. Both of these medications work to prevent the conversion of prothrombin to thrombin and stop clot formation. The differences start with the doses. Xarelto is usually taken once per day and Eliquis is taken twice per day.
Absorption and metabolism are also different between the two drugs. Apixaban absorption is not affected by food or stomach acid and it can be taken with or without food at any time of day. This medication has a half-life of about 12 hours and requires twice-daily dosing for stable blood levels.
Rivaroxaban absorption depends on food and stomach acidity – especially at 15 mg and 20 mg doses – which must be taken with food to get full effectiveness. This medication also has a shorter half-life (five to nine hours in young patients and 11 to 13 hours in older patients). Rivaroxaban is mostly used once a day for convenience (unless taken for CAD or PAD). However, this can cause its blood levels to fluctuate more than with apixaban.
These medications are both used to help stop blood clots and stroke from occurring in adults with nonvalvular AFib. Both medications are also prescribed to treat or prevent DVT and PE. Use for prevention is more common for patients undergoing a hip or knee replacement. It may be used for prevention after those conditions have been treated.
Xarelto has also been approved for use in preventing venous thromboembolism (VTE) of patients who have been hospitalized with an illness. It has also been approved for use in preventing major cardiovascular events for adult patients with coronary artery disease or to prevent blood clot issues for those with peripheral artery disease.
Adults with AFib are usually prescribed 5 mg twice daily. This amount may be reduced to 2.5 mg twice daily if the patient is 80 years old or older, or if they are less than or equal to 60 kg (about 132.3 lbs). The same applies if the patient’s serum creatinine is 1.5 mg/dL or higher.
The usual starting dose is 10 mg twice daily for seven days for DVT or PE treatment. This is typically followed by 5 mg twice daily. The maintenance dose is 2.5 mg twice daily after at least six months of initial therapy to reduce the risk of recurrent DVT or PE.
The dose of this medication is 2.5 mg twice daily – starting 12–24 hours after the procedure – and is continued for 35 days after hip replacement or 12 days after knee replacement for DVT prevention after surgery.
Dose adjustments are not usually needed for mild or moderate kidney issues unless the patient meets the criteria for the lower dose. Using this medication is not recommended in cases of severe liver impairment. Interrupting treatment or missing doses can put patients at higher risk for strokes or blood clots.
The usual dose of Xarelto is 20 mg once daily with meals for adults with AFib. Patients with reduced kidney function – CrCl less than or equal to 50 mL/min – usually are prescribed a lower dose of 15 mg once daily. This dose will still need to be taken with a meal.
Therapy begins with 15 mg twice daily for the first 21 days – taken with food – for treating DVT and PE. The maintenance dose is 20 mg once daily with food. This should be continued for at least three to six months (as directed by the patient’s doctor). The dose for reducing the risk of recurrent DVT or PE after initial therapy is usually 10 mg once daily.
This medication should not be used if the patient’s CrCl is below 15 mL/min. Doses of 15 mg or higher must always be taken with food to ensure full absorption. Skipping doses or taking them without food may reduce effectiveness and increase clotting risk.
Eliquis commonly causes bleeding or bruising in adult patients. Common side effects for children taking the medication include headache, vomiting, and heavy menstrual bleeding. GI upset may also occur in patients. Some studies do show that this medication does have lower risk of causing GI bleeding.
This medication may also cause an increased risk of blood clots if the medication is suddenly stopped. Patients receiving spinal anesthesia or punctures are also at increased risk of spinal or epidural blood clots. Both of these are boxed warnings for the medication. Major bleeding is another possible serious side effect.
Xarelto also commonly causes an increased risk of bleeding and bruising. Patients taking this medication may also experience side effects such as nosebleeds. GI upset or inflammation of the stomach/gut may also occur while taking this medication. Children taking the medication also sometimes experience side effects such as vomiting or coughing. This medication needs to be taken with food (especially in higher doses) to improve absorption of the medication and reduce the occurrence of stomach issues.
Patients who suddenly stop taking this medication are at increased risk of blood clots or having a stroke. This medication also has a warning for patients who are taking this medication while having a spinal or epidural area injection. This medication may cause blood clots for those patients. These are both boxed warnings for the medication. Rare liver enzyme elevations also occur on some occasions.
Patients who plan on stopping either medication should discuss this with their doctor before doing so. Stopping the medication suddenly can be dangerous and patients should not do so without a doctor’s supervision.
Both Xarelto and Eliquis have similar interaction profiles. They both interact with drugs that affect the CYP3A4 and P-glycoprotein pathways. This includes medications such as antifungals or antivirals. It also includes anticonvulsants.
It can be dangerous mixing either medication with another medication that is also known to increase a patient’s bleeding risk. This includes medications like aspirin or NSAIDs. It may also include medications like heparin or clopidogrel. Some antidepressants – like SSRIs – may also increase bleeding risk. Combining any of these medications with other blood thinners or NSAIDs should be avoided unless it has been directed by a doctor.
Andexxa (andexanet alfa) is the approved reversal agent for both Eliquis and Xarelto. This drug works by reducing anti-Factor Xa activity and stopping bleeding. It is used to reverse the effects of anticoagulation in instances of bleeding that is uncontrolled. This can help make surgeries safer and restore normal clotting activity in the body. This medication is important and can help patients avoid life-threatening events. There may be limitations on availability in certain instances.
Xarelto has a retail price of around $600. However, patients with eligible commercial insurance can pay as little as $10 per 30- to 90-day supply through the Xarelto withMe Savings Program. Medicare Part D may also cover part of this medication for some patients – with an annual savings cap of $2,000. The expected out-of-pocket costs for those using their Medicare Part D coverage are $102.32 per month. Generic rivaroxaban was approved earlier in 2025. Prices of this medication version vary (but are often cheaper than the name brand).
The retail price of Eliquis is also usually around $600. Patients with commercial insurance coverage usually pay an average of about $38 per month. There is also an ELIQUIS $10 Co-pay Card available. Patients using Medicare coverage spend about an average of $54 per month. No true generic version of this medication is yet available.
Patients without coverage may still be able to save on these medications when purchasing them from safe international pharmacies or when using online coupons or programs.
Pros
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Pros
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Both Xarelto and Eliquis are usually effective and safe when taken as prescribed. The decisions about which medication is better usually have more to do with factors such as dosing preference (once vs. twice daily) and cost/insurance coverage. Eliquis may also be preferred in patients with reduced kidney function or in older adults. The decision may also depend on the experience of the patient’s doctor. Doctors may have more familiarity with one medication based on patient outcomes and practice patterns. Patients wanting to switch to one of these medications should make sure to discuss all health factors with their healthcare provider first.
Both Xarelto and Eliquis are Factor Xa inhibitors and work through the same pathway to prevent blood clots. However, they differ in how they are taken. Xarelto is usually dosed once daily in most cases and Eliquis is taken twice daily. Timing is important when switching between these medications. Missing a dose or delaying the switch may create a gap in anticoagulation and increase the risk of a blood clot or stroke. Taking these medications too close together could also increase the risk of bleeding.
The first dose of Eliquis is taken at the time the next Xarelto dose would have been due when stopping Xarelto. However, every patient should get individualized medical direction – especially patients with kidney impairment or recent bleeding events. Doses and timing should never be changed without physician oversight.
Eliquis is taken twice daily and Xarelto is generally taken once daily with food. Switching to Xarelto from Eliquis is usually done at the time of the next scheduled Eliquis dose. This means that the next Eliquis pill is skipped and Xarelto is taken instead. The transition may require careful adjustment based on the indication. For example, if it is being used to treat AFib vs. DVT/PE. Other patient factors may also have an effect.
Patients should seek individualized guidance from their healthcare provider before making the switch (as with all anticoagulant changes). Medical monitoring is also advised during this process. Medical monitoring is recommended to check for any signs of bleeding or clotting.
Both Xarelto and Eliquis give off comparable anticoagulation effects. However, they are different when it comes to pharmacokinetics. Switching between these two medications may be called for if the patient experiences changes in insurance coverage or medication costs. It may also be a good idea if the patient is experiencing any side effects or tolerance issues with their current therapy. Some patients may also switch to Xarelto if they prefer a simpler dosing schedule.
Stopping either medication abruptly without a suitable replacement can significantly increase the risk of blood clots or stroke. Always consult a healthcare provider or pharmacist before making any changes to anticoagulant therapy. They will be able to provide more personalized instructions.
Both medications are effective and approved for preventing blood clots and stroke. However, several studies suggest that Eliquis may cause fewer major bleeding events.
Yes. Switching should only be done with professional medical supervision. Timing and dose must be carefully adjusted to prevent either bleeding or clotting risks. Patients should never switch medications on their own without talking to their doctor or pharmacist.
The prices of these two medications are comparable for the name brands (at around $600 per month). However, a generic version of Xarelto (rivaroxaban) that may be cheaper is now available.
Both drugs share similar side effects such as bleeding and bruising. However, Eliquis has been associated with a slightly lower overall risk of bleeding in major clinical studies.
A generic version of Xarelto (rivaroxaban) became available in early 2025.
Xarelto must be taken with food if the dose is 15 mg or higher. Eliquis does not necessarily need to be taken with food. Both medications should be used cautiously with alcohol since this could increase the risk of bleeding.
A missed dose should be taken as soon as remembered – provided it is still within the same day. Patients taking Eliquis should skip the dose if it means taking two within the same day and continue with their dosing schedule as usual the day following the missed dose.
Patients taking Xarelto once per day should also only do this if they remember the missed dose within the same day they were supposed to take it and or skip this dose and proceed normally if it is the next day. However, if they are taking the medication twice per day, they may take two doses at once to make up for the dose that was missed (on the same day).
Eliquis and Xarelto are both trusted and proven anticoagulants. Some patients may prefer Eliquis because of its accompanying studies that show this medication option causes less bleeding. However, others may prefer Xarelto for its once-daily dosing. The best option for the patient depends on their health and preferences. Medical professionals can help them make the most educated decision. Patients should always consult their healthcare provider before starting, stopping, or switching anticoagulants.
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Written & Reviewed By
The MyRx Team
The MyRx Outlet team is a dedicated group of healthcare professionals and pharmacists dedicated to delivering up-to-date and accurate information on medications and key healthcare topics. With years of experience in the healthcare field, our team is passionate about supporting individuals in reaching their health and wellness goals through our articles.
The information provided here is for educational purposes only and is not intended to serve as medical advice, diagnosis, or treatment recommendations. It should not be taken as an endorsement of any specific medication or treatment. Individual health conditions and responses to treatment can vary greatly; therefore, this information should not be seen as a guarantee of safety, suitability, or effectiveness for any particular individual. Always consult with a healthcare professional for personalized medical advice and before making any decisions regarding your health or treatment plans.
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