Eliquis vs. Xarelto to Prevent and Treat Blood Clots
Key takeaways:
Eliquis (apixaban) and Xarelto (rivaroxaban) are in the same group of medications called direct oral anticoagulants (DOACs). DOACs are effective medications for preventing and treating blood clots.
The most common side effect of DOACs is abnormal bleeding. But sometimes the bleeding can become life-threatening. Tell your healthcare provider right away if you notice any unusual bruising and bleeding.
One DOAC isn’t preferred over another to prevent or treat blood clots. Your healthcare provider may choose one based on your medical history and personal preferences.
Table of contents
Blood clotting is normal when it happens in response to bleeding. But when your blood clumps together without good reason, it can be dangerous. Clots can travel to the lungs (pulmonary embolism) or brain (stroke), which can be life-threatening. In fact, blood clots are a common cause of death in the U.S.
For over 50 years, warfarin (Coumadin, Jantoven) was the first-choice anticoagulant (blood thinner) to prevent blood clots. But warfarin requires regular blood tests to make sure the dose is correct.
In more recent years, newer anticoagulants became FDA approved to prevent and treat blood clots in many situations, including in people with atrial fibrillation. These medications — called direct oral anticoagulants (DOACs) — don’t require regular blood tests, and some may be less likely to cause serious bleeding.
DOACs Eliquis (apixaban) and Xarelto (rivaroxaban) work in the same way and have common side effects. Still, there are differences between these medications that you should know about. Keep reading to learn how Eliquis and Xarelto compare.
What is Eliquis?
Eliquis is a DOAC medication that comes as a 2.5 mg or 5 mg tablet. It’s only available as a brand-name medication.
What conditions is Eliquis approved to treat?
Eliquis is FDA approved to prevent and treat blood clots in adults only. It can be used in various situations, including:
Lower the risk of blood clots and stroke in people with nonvalvular atrial fibrillation (not caused by heart valve problems)
Lower the risk of blood clots in deep veins of the body — known as deep vein thrombosis (DVT) — after hip or knee replacement surgery
Treat DVT or pulmonary embolism (PE)
Lower the risk of repeat DVT and PE
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What is Xarelto?
Like Eliquis, Xarelto is only available as a brand-name medication. It’s available as a liquid suspension (1 mg per mL) and in tablet form.
Xarelto tablets are available in the following dosages:
2.5 mg
10 mg
15 mg
20 mg
What conditions is Xarelto approved to treat?
Xarelto is FDA approved for all the same uses as Elqiuis — and a few more.
Xarelto’s FDA-approved uses are:
Lower the risk of blood clots and stroke in people with nonvalvular atrial fibrillation
Lower the risk of serious heart-related problems (e.g., heart attack) in people with coronary artery disease (CAD), when combined with aspirin
Prevent DVT or PE in people who've had recent hip or knee surgery
Prevent blood clots in people who are hospitalized, or who are at high risk of blood clots after leaving the hospital
Treat DVT or PE
Lower the risk of repeat DVT or PE in adults and children of all ages
Lower the risk of major complications due to blood clots in people with peripheral artery disease, when combined with aspirin
Prevent blood clots in children at least 2 years old who have congenital heart disease and have had a surgical procedure called the Fontan procedure
How do Eliquis and Xarelto work to treat and prevent blood clots?
DOACs such as Eliquis and Xarelto are known as direct factor Xa inhibitors.
Direct factor Xa inhibitors work by blocking a protein known as factor Xa, which is a vital part of the blood-clotting process. Blocking the activity of factor Xa helps prevent blood clots from forming.
How are Eliquis and Xarelto dosed?
The dosage and treatment length of Eliquis and Xarelto depends on what you’re taking it for. The recommended dose of Xarelto might be lower if you have kidney problems.
Eliquis can be taken with or without food. When Xarelto is used in cases of atrial fibrillation, or to treat DVT or PE, it should be taken with food. Otherwise, it can be taken with or without food.
Typical dosing instructions for Eliquis and Xarelto are as follows:
|
Indication |
Eliquis |
Xarelto |
|
Nonvalvular atrial fibrillation |
5 mg twice daily for most adults, and 2.5 mg twice daily in certain situations |
20 mg once daily for most adults, and 15 mg once daily in some people with kidney problems |
|
DVT prevention after hip or knee replacement surgery |
2.5 mg twice daily |
10 mg once daily |
|
Treatment of DVT and PE |
10 mg twice daily for 7 days, followed by 5 mg twice daily |
15 mg twice daily for the first 21 days, followed by 20 mg once daily |
|
Lowering the risk of recurrent DVT or PE (after initial treatment) |
2.5 mg twice daily |
10 mg once daily |
|
Preventing blood clots in hospitalized patients or patients who just left the hospital and are at high risk |
Not approved |
10 mg once daily |
|
Lower risk of blood clots in CAD or PAD |
Not approved |
2.5 mg twice daily, in combination with aspirin (75 mg to 100 mg) once daily |
When Xarelto is used in children, the dose will depend on how much they weigh.
How effective are Eliquis and Xarelto for treating and preventing blood clots?
Eliquis and Xarelto are both first-choice treatment options for treating and preventing deep vein thrombosis or pulmonary embolism. DOACS are also first-choice medication options for preventing blood clots in most people with nonvalvular atrial fibrillation. But there are exceptions, including people with severe liver disease or antiphospholipid syndrome (an immune disorder that causes blood clots).
In general, one DOAC isn’t recommended over another. But one DOAC might be better in specific situations. For example:
Eliquis may be the better choice if you have kidney problems.
If you have trouble remembering to take your medications, a DOAC that you can take once a day (like Xarelto) may be a better option than a DOAC that’s taken twice a day (like Eliquis).
Only Xarelto is FDA approved for certain uses in children.
Your healthcare provider will determine which is right for you based on your medical history, current medications, preferences, and other factors.
What are the known side effects of Eliquis and Xarelto?
The most common side effect of Eliquis and Xarelto in adults is abnormal bleeding. This can include bleeding gums or nosebleeds. It can also include heavier bleeding during your period, rectal bleeding, and blood in the urine. If you experience any unusual bleeding while taking Eliquis or Xarelto, you should contact your healthcare provider. They can help you determine how serious the bleeding is.
Eliquis can also cause bruising and nausea. In clinical studies, Xarelto was shown to cause the following side effects in some people:
Abdominal pain
Back pain
Dizziness
Itchiness
The most common side effects in children taking Xarelto are:
Bleeding
Cough
Vomiting
Stomach flu
Tiredness
Pain in various body parts, including shoulders, arms, and legs
Rash
What are the serious side effects of Eliquis and Xarelto?
Eliquis and Xarelto may cause some serious side effects. Side effects include:
Risk of blood clot-related side effects, including a heart attack or stroke, if Xarelto or Eliquis is stopped too early. Don’t stop taking these medications without talking to your healthcare provider first.
Paralysis in the spine after a spinal tap or epidural. These procedures can lead to blood pooling near the spine, which puts pressure on the spine that can lead to paralysis. Your healthcare provider should give you instructions on stopping and restarting these medications if you have a surgery planned.
Life-threatening bleeding may occur with Eliquis or Xarelto treatment. Contact your healthcare provider immediately if you notice any unusual bleeding while taking these medications.
While bleeding from Xarelto and Eliquis may be reversible, it’s not always easy. Andexxa (recombinant coagulation factor Xa recombinant, inactivated-zhzo) — an intravenous (IV) medication that can reverse the effects of Xarelto and Eliquis — is expensive and has to be given in a hospital setting.
What drug interactions do Eliquis and Xarelto have?
Drug interactions can occur with Eliquis and Xarelto. It’s best to provide your current medication list to your healthcare provider and pharmacist. They can double-check for interactions and provide you with the best advice.
Medications that raise the risk of bleeding
Since Eliquis and Xarelto can raise your bleeding risk, taking it with other medications that also raise bleeding risk can be dangerous. These include:
Aspirin
Non-steroidal anti-inflammatory medications (NSAIDs)
Clopidogrel (Plavix)
Some antidepressants, like selective serotonin reuptake inhibitors (SSRIs)
Sometimes, taking one of these medications along with Eliquis or Xarelto may be necessary. Your healthcare provider can help you weigh the risks and benefits.
Medications that raise or lower the levels of Eliquis or Xarelto
Some medications can lower or raise the amount of Eliquis or Xarelto in your body. If the level of either medication is too high, dangerous bleeding can occur. If the levels are too low, the medication may not work well, and blood clots can form.
Eliquis and Xarelto may build up in the body and lead to bleeding if you take certain medications. These medications include ketoconazole, itraconazole (Sporanox), ritonavir (Norvir).
On the other hand, Eliquis and Xarelto may not work as well and lead to blood clots if you take certain medications and herbal products. These include:
Carbamazepine (Tegretol)
Phenytoin (Dilantin, Phenytek)
The examples listed above may not include all potential interactions with Eliquis and Xarelto. Check with your healthcare provider or pharmacist before starting a new medication or herbal product.
How much do Eliquis and Xarelto cost?
Eliquis and Xarelto are only available as brand-name medications. The average retail price for a 30-day supply of Eliquis and Xarelto can be over $600. But you may be able to save over $75 on either medication at certain pharmacies with a free GoodRx coupon.
Should I take Eliquis and Xarelto together for blood clots?
No. Both medications work the same way to prevent and treat blood clots. Taking Eliquis and Xarelto together can raise your chance of developing serious bleeding, too.
If you’re having any bothersome side effects or bleeding from Eliquis or Xarelto, talk to your healthcare provider. They can talk to you about other treatment options.
The bottom line
Eliquis and Xarelto are first-choice options in preventing and treating certain types of blood clots. They’re part of a medication class called DOACs. They’re both only available as brand-name medications and can be expensive. Eliquis is usually taken twice a day only, and Xarelto is usually taken once a day.
The most common side effect of these medications is bleeding, and sometimes this can be life-threatening. If you experience bleeding from Eliquis or Xarelto, contact your healthcare provider immediately.
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References
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