Eliquis vs Xarelto: Which DOAC Is Better for You?

• Eliquis (apixaban): This blood thinner helps prevent strokes and treat clots by blocking factor Xa. It's usually taken twice daily. Studies suggest it might have a lower risk of bleeding compared to Xarelto, especially in older adults. A generic is approved but not yet widely available due to patents.
• Xarelto (rivaroxaban): Also a factor Xa blocker, Xarelto is used for similar conditions as Eliquis, with some broader uses, including for children and alongside aspirin for certain heart conditions. Dosing varies (once or twice daily), and some doses require food. A generic 2.5 mg strength was recently approved.
• Key Differences: Eliquis may have a favorable bleeding profile, especially in older patients. Xarelto has more approved uses, including for children and specific cardiovascular conditions. Generic availability differs, with a generic Xarelto (2.5 mg) being the first to become available.
• Important Considerations: Both medications carry a bleeding risk. Never stop taking them without consulting your doctor, as this can increase your risk of dangerous blood clots. Always discuss your medical history, kidney function, and other medications with your doctor to determine the best choice for you.

For years, warfarin was the primary treatment for preventing strokes and managing blood clots. But it required frequent blood tests, regular dose adjustments, and dietary restrictions.

Advances in research led to the development of newer medications called direct oral anticoagulants (DOACs). These drugs work differently than warfarin. They do not require routine blood monitoring and are generally simpler to take. Two common DOACs are Eliquis and Xarelto.

Xarelto received FDA approval in 2011, and Eliquis followed in 2012. Both medications are used to treat deep vein thrombosis (DVT) and pulmonary embolism (PE). They also reduce the risk of stroke in patients with non-valvular atrial fibrillation.

Although Eliquis and Xarelto belong to the same drug class, they have some differences, notably in the availability of generic versions.

A generic version of Eliquis was approved back in 2019, but because of patent protections, it will not be available until at least 2026 or 2028.

Xarelto, on the other hand, now has a generic option. On March 4, 2025, the FDA approved the first generic version of Xarelto in the 2.5 mg strength. This generic will be available in the U.S. in the coming months, though a specific release date has not yet been confirmed.

How They Work

Both Eliquis (apixaban) and Xarelto (rivaroxaban) prevent blood clots by targeting a specific protein in your body called factor Xa. This enzyme plays a key role in clot formation.

• It converts prothrombin into thrombin.
• Thrombin then produces fibrin, a protein that forms and stabilizes blood clots.

By blocking factor Xa, Eliquis and Xarelto stop this reaction, therefore, prevent clots from forming or growing larger.

What Conditions Do They Treat?

Both medications are used to treat and prevent blood clots, but they have some differences in approved uses.

Eliquis

Used in adults to:

• Reduce the risk of stroke and clot-related complications in AFib not caused by a heart valve issue
• Treat and prevent recurrence of deep vein thrombosis (DVT) and pulmonary embolism (PE)
• Prevent DVT after hip or knee replacement surgery

Note: Eliquis is not approved for use in children.

Xarelto

Used in adults to:

• Treat and prevent DVT and PE
• Reduce stroke risk in non-valvular AFib
• revent clots after hospitalization or orthopedic surgery
• Reduce the risk of heart attack, stroke, or reduced blood flow to the legs in people with:
  • Coronary artery disease (CAD)
  • Peripheral artery disease (PAD): when used with low-dose aspirin

Additional Use: Xarelto is approved for use in children to:

• Treat blood clots
• Prevent clot recurrence, including after heart surgery

Choosing between Eliquis and Xarelto depends heavily on the specific condition being treated and patient-specific factors. For example, kidney function can influence which medication is safer. Eliquis is often preferred for patients with kidney problems. Doses for both Xarelto and Eliquis may be adjusted for those with reduced kidney function.

How Are They Taken?

Eliquis

• Form and Strengths: Tablet; 2.5 mg, 5 mg
• Dosing: Typically taken twice daily. Can be taken with or without food.
• Note: Take doses at the same time each day to maintain consistent levels in the body. No specific dietary restrictions.

Xarelto

• Form and Strengths: Tablet, oral suspension; 2.5 mg, 10 mg, 15 mg, 20 mg
• Dosing: Depends on the condition being treated. May be taken once or twice daily.
• Food Requirements::
  • 15 mg and 20 mg tablets: Must be taken with food for proper absorption
  • 2.5 mg and 10 mg tablets: Can be taken with or without food
• Special Instructions: Tablets can be crushed and mixed with applesauce for easier swallowing, but must be taken immediately after mixing
• Pediatric Use:
  • If a child vomits within 30 minutes of taking a dose: Repeat the dose
  • If vomiting occurs after 30 minutes: Do not repeat; continue with the next scheduled dose

Important: Stopping either Eliquis or Xarelto without telling your doctor can lead to serious complications from blood clots. Always consult your healthcare provider before making any changes to your medication.

Side Effects

Eliquis

Common Side Effects (mild and not dangerous on their own):

• Easy bruising
• Nosebleeds
• Bleeding gums (especially when brushing or flossing)

Signs of Serious Bleeding (seek immediate medical attention):

• Vomiting blood
• Black or bloody stools
• Unexplained dizziness or fainting

Other Warning Signs:

• Swelling, redness, or warmth in a limb (possible blood clot)
• Sudden confusion, numbness on one side, or trouble speaking (possible stroke)

Xarelto

In Adults: leeding is the most common side effect

In Children:

• Bleeding
• Coughing
• Vomiting
• Rash
• Fever
• Stomach issues (nausea, diarrhea, viral gastroenteritis)

Signs of Serious Bleeding (same as Eliquis):

• Vomiting blood
• Blood in urine or stool
• Bleeding that won’t stop

What to Do If You Experience a Serious Side Effect

Contact your healthcare provider immediately if you notice:

• Unusual bruising
• Persistent bleeding
• Blood in urine or stool
• Stroke symptoms (confusion, slurred speech, weakness on one side)

Do not stop taking Eliquis or Xarelto without medical advice—even if you feel fine. Stopping suddenly can increase your risk of a dangerous blood clot.

Comparing Safety: Eliquis vs. Xarelto

Recent studies suggest that while both medications are effective at preventing strokes and clots, their bleeding risks differ:

• A large study of over 24,000 patients with venous thromboembolism (VTE) found: Eliquis had lower rates of major and non-major bleeding compared to Xarelto.
• Another study of over 580,000 older adults with atrial fibrillation showed: Eliquis was linked to a lower risk of stroke and severe bleeding than Xarelto.
• A nationwide cohort study confirmed: Rivaroxaban (Xarelto) had higher rates of major bleeding, especially gastrointestinal bleeding, compared to apixaban (Eliquis).

Speak With Your Doctor

Eliquis and Xarelto are both reliable options for preventing strokes and treating blood clots. In many cases, either medication may be suitable. However, one might be a better choice for you depending on factors like:

• The specific condition being treated
• Other medications you're taking
• Your kidney function
• Your age

If you've been prescribed one of these medications or are considering a switch, it's always a good idea to talk with your doctor or pharmacist. They can explain how the medication fits into your treatment plan and what to watch for while taking it.

Always remember to report any unusual symptoms or concerns, especially signs of bleeding. And never make changes to your medication routine without medical guidance.