Xarelto vs. Eliquis: What's the Difference? - Verywell Health
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Your healthcare provider may recommend using anticoagulant medications (blood-thinning medications) to treat or prevent blood clots.
Blood-thinning drugs can treat or prevent deep vein thrombosis (DVT, a blood clot, usually in the leg) and pulmonary embolism (PE, a blood clot in the lung), among other conditions stemming from blood clots, in adults.
Blood thinners are a crucial form of medication in the United States. To date, more than half of all Americans 18 and older take one or more blood thinners.
Notable options include Xarelto (rivaroxaban) and Eliquis (apixaban), two prescription-based, orally administered medications that are categorized as factor Xa inhibitors (drugs that keep your blood from clotting too much).
These Food and Drug Administration (FDA)–approved prescription drugs are used to prevent and treat various blood clots.
Although both medicines are in the same drug class, they share some distinct differences that potential users should be aware of. Read on for an in-depth analysis of Xarelto vs. Eliquis.
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What Is Xarelto?
The following will outline the purposes for which Xarelto is used, alongside an explanation of how the drug works within the body to create its desired effects.
Approved & Off-Label Uses
Xarelto is FDA-approved for the following conditions in adults:
- Lower the risk of stroke and systemic embolism (clots that travel through the circulatory system) in people with nonvalvular atrial fibrillation (Afib, a type of irregular heartbeat that is not caused by a problem with a heart valve)
- To treat DVT
- To treat PE
- To lower the risk of a DVT or PE from returning
- To prevent DVT (which can lead to PE) in individuals who are having knee replacement or hip replacement surgery
- To prevent clots in individuals who are hospitalized and at risk for blood clots
- To lower the risk of cardiovascular (heart) events (heart attack, stroke, or death) in people with coronary artery disease (CAD; damage to the heart's major blood vessels due to plaque build-up)
- To lower the risk of clotting in people with peripheral artery disease (PAD; poor circulation to the legs due to plaque build-up in the arteries), including individuals after recent lower extremity revascularization (surgery to improve blood flow)
Xarelto is FDA-approved for the following conditions in children and adolescents:
- To treat and lower the risk of clots in people younger than 18
- To prevent clots in children 2 and older who have congenital heart disease (CAD, a heart condition that develops before birth) following a Fontan procedure, a type of open-heart surgery
Sometimes, healthcare providers prescribe an approved drug for a condition or in a manner that is not FDA-approved. This is called off-label prescribing.
Healthcare providers sometimes prescribe Xarelto off-label to prevent blood clots after percutaneous coronary intervention (PCI, previously known as angioplasty with a stent).
Angioplasty involves opening up blocked or narrowed blood vessels in the heart in people with nonvalvular Afib.
How Does Xarelto Work?
Xarelto is a direct-acting oral anticoagulant (DOAC) or a factor Xa inhibitor. Standard blood thinners, such as Jantoven (warfarin), require blood tests and dietary restrictions and carry a risk of uncontrolled bleeding.
In comparison, DOACs are highly effective and don't require regular blood testing or special diets.
Xarelto works by decreasing the production of thrombin, an enzyme that causes clotting. Doing so helps prevent and treat conditions related to blood clots.
Xarelto is available as a tablet that is taken by mouth. It is also available as an oral suspension (liquid).
What Is Eliquis?
The following will outline the purposes for which Eliquis is used, alongside an explanation of how the drug works within the body to create its desired effects.
Approved & Off-Label Uses
Eliquis is FDA-approved for the following conditions in adults only:
- Lower the risk of stroke and blood clots in people with nonvalvular Afib
- Prevent DVT (which can lead to PE) after hip or knee replacement surgery
- Treat DVT
- Treat PE
- Lower the risk of DVT and PE from recurring after initial treatment
Healthcare providers sometimes prescribe Eliquis off-label for the following uses:
- Treat low platelet levels due to a blood thinner called heparin
- Prevent and treat DVT associated with cancer
- Prevent clots in individuals who are hospitalized and at risk for blood clots
- Prevent blood clots after PCI
How does Eliquis Work?
Like Xarelto, Eliquis is an oral anticoagulant—also called a DOAC or a factor Xa inhibitor.
Eliquis works by decreasing the production of thrombin, which helps prevent and treat conditions related to blood clots. Eliquis is available as a tablet that is taken by mouth.
Dosing Comparison
The following information provides general guidelines for Xarelto and Eliquis dosing in adults.
Your healthcare provider will give you directions on taking Xarelto and Eliquis, including how long you should take the medication and any other considerations.
Follow your healthcare provider's instructions closely, and ask your provider any questions regarding dosing.
Xarelto
The following dosages are for adults with normal kidney function. Those with kidney problems may need a lower dosage or will need to avoid using Xarelto. For children, the dosage depends on their age and weight.
Standard dosing regimens for Xarelto are as follows:
- To lower the risk of stroke in people with nonvalvular Afib: Take 20 milligrams (mg) once daily with the evening meal.
- To treat DVT and/or PE: Take 15 mg twice daily for 21 days, then 20 mg once daily with food.
- To lower the risk of recurrence of DVT and/or PE: Take 10 mg once daily (with or without food) after at least six months of standard anticoagulant treatment.
- To prevent DVT after hip replacement: Take 10 mg once daily (with or without food) for 35 days, starting 6–10 hours after surgery.
- To prevent DVT after knee replacement: Take 10 mg once daily (with or without food) for 12 days, starting 6–10 hours after surgery.
- To prevent clots in hospitalized individuals: Take 10 mg once daily (with or without food) in the hospital and after discharge for 31 to 39 days.
- To lower the risk of heart events in people with CAD: Take 2.5 mg twice daily (with or without food), plus aspirin (75–100 mg) once daily.
- To lower the risk of clots in people with PAD: Take 2.5 mg twice daily (with or without food), plus aspirin (75–100 mg) once daily.
Eliquis
The following dosages are for adults with normal kidney function. Those with kidney problems may need a lower dosage or will need to avoid using Eliquis.
Standard dosing regimens for Eliquis are as follows:
- To lower the risk of stroke and blood clots in people with nonvalvular Afib: Take 5 mg twice daily. However, some people take 2.5 mg twice daily if they have at least two of the following indications: age 80 or older, body weight 132 pounds or less, or serum creatinine (a measure of kidney function) 1.5 milligrams per deciliter (mg/dL) or higher.
- To prevent DVT (which can lead to PE) after hip or knee replacement surgery: Take 2.5 mg twice daily, starting 12 to 24 hours after surgery—for a total of 35 days for hip replacement or 12 days for knee replacement.
- To treat DVT or PE: Take 10 mg twice daily for seven days, then 5 mg twice daily after that.
- To lower the risk of DVT and PE from reoccurring after initial treatment: Take 2.5 mg twice daily after at least six months of treatment.
Comparative Efficacy
It's important to note that both drugs have undergone clinical trials to ensure they are effective and safe. Still, only your healthcare provider can determine which medication is more appropriate for you based on individual factors. We can provide some general information on studies and what has been found.
A meta-analysis (combining results from two or more separate studies) of over 24,000 individuals found that Xarelto and Eliquis had similar efficacy in preventing blood clots but that people who took Eliquis had fewer bleeding episodes.
Another study compared Eliquis, Xarelto, Pradaxa (dabigatran), and Jantoven. The researchers found Eliquis to be the most favorable in terms of efficacy and safety.
A study published in the Annals of Internal Medicine found that those who took Xarelto had more bleeding and slightly more incidences of clotting than Eliquis.
One study published in the Journal of the American Medical Association (JAMA) found that in older adults (65 and older), people who took Xarelto had more incidences of bleeding and clotting than those who took Eliquis.
Alternative Treatment Options
The National Blood Clot Alliance (NBCA) recommends the following in addition to taking your prescribed medication:
Determine if you are at risk of blood clots risk and inform your healthcare provider. Your family and medical history, including recent surgeries, may indicate whether you could experience blood clots.
Recognize the signs and symptoms of blood clots. The National Blood Clot Alliance uses the slogan "STOP the CLOT," in which each letter indicates a symptom.
"STOP" stands for swollen legs, tenderness in the legs, shortness of breath, and passing out (feeling lightheaded). "CLOT" stands for chest pain, leg discoloration, overdrive (feeling like the heart is racing), and time (to call 911).
Tell your healthcare provider if you have any risk factors for blood clots, especially before any surgery. If you have any blood clot symptoms, get medical attention immediately.
If you are resting in a hospital or home, ask your healthcare provider about the best ways to prevent blood clots. When traveling on a plane, a train, or in a car, take a break at least every two or three hours so you can get up, walk around, and stretch your legs.
Maintain a healthy weight. Consult a registered dietitian to help you design an eating and exercise plan that fits your lifestyle.
Finally, do not smoke or vape. If you do, ask your healthcare provider for recommendations on how to stop.
Side Effects & Safety
Like all drugs, Xarelto and Eliquis carry the potential for side effects.
Be aware of these side effects and consult a healthcare provider if you experience symptoms that worsen or fail to stop.
Xarelto and Eliquis have a black box warning, the most severe warning required by the FD.
The warning states the following:
- Stopping Xarelto or Eliquis too soon increases the risk of blood clots.
- Additionally, epidural hematomas (a collection of blood between the skull and the outer covering of the brain) or spinal hematomas (a collection of blood in the spinal canal) may occur in people who take Xarelto or Eliquis, receive local anesthesia in or around the central nervous system, or are undergoing a spinal tap.
- These hematomas may lead to long-term or permanent paralysis.
Common Side Effects
Bleeding is the most common side effect of Xarelto and Eliquis, ranging from mild to life-threatening.
Other common side effects of Xarelto in adults include back pain, stomach pain, and dizziness. In comparison, common Xarelto side effects in children include cough, vomiting, and fatigue.
Conversely, other common side effects of Eliquis include anemia and nausea.
Severe Side Effects
Serious side effects may occur as a result of using Xarelto or Eliquis. Call your healthcare provider right away if you have serious side effects. Call 911 if your symptoms feel life-threatening, or you think you have a medical emergency.
Serious side effects and their symptoms can include the following:
This is not a complete list of side effects, and others may occur. Call your healthcare provider if you have unusual problems while taking this medication.
If you experience a severe side effect, you or your provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).
Precautions
Before taking Xarelto or Eliquis, tell your healthcare provider about your medical conditions, medical history, and family history.
Always ask your healthcare provider for advice if you are pregnant or breastfeeding.
You should not take Xarelto or Eliquis if you are allergic to any ingredient in the medication or if you are actively bleeding.
Xarelto and Eliquis are also contraindicated (should not be used) in people:
- With a certain degree of liver or kidney problems
- With acute pulmonary embolism
- Who have a prosthetic heart valve
- Who have an autoimmune condition called antiphospholipid syndrome
- Who are pregnant or breastfeeding
Potential Adverse Interactions
Tell your healthcare provider about all your medicines, including prescription, over-the-counter (OTC), and vitamins or supplements.
While taking Xarelto or Eliquis, do not start any new medications without approval from your healthcare provider.
Some examples of drug interactions include:
- Anticonvulsant medications, such as Dilantin (phenytoin) or Tegretol (carbamazepine)
- Drugs used for the treatment of human immunodeficiency virus (HIV), such as Norvir (ritonavir)
- Drugs used for the treatment of severe bacterial infections, such as Rifadin (rifampin)
- Natural dietary supplements used for the treatment of depression, such as St. John's wort
- Other medications that can thin the blood, such as Lovenox (enoxaparin), Jantoven (warfarin), Aspirin (although low-dose aspirin is used for some indications with Xarelto), Plavix (clopidogrel), or nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil (ibuprofen)
This is not a complete list of drug interactions. Other drug interactions may occur with Xarelto or Eliquis.
Consult your healthcare provider for more information about drug interactions and how they may affect you.
Staying Safe on Blood Thinners
While taking a blood thinner, be alert to signs and symptoms of bleeding, such as:
- Heavy menstrual bleeding
- Red or brown urine
- Red or black bowel movements
- Nosebleeds or bleeding gums that do not stop quickly
- Bright red or brown vomit or coughing up something red
- Severe headache or stomach pain
- Unusual bruising
- A cut that does not stop bleeding
- A fall or bump on the head
- Dizziness
- Weakness
Some tips for staying safe while taking a blood thinner include:
- Use extra caution with sharp tools like knives and scissors.
- Use an electric razor rather than a manual one.
- Use a soft toothbrush and waxed dental floss. Avoid the use of toothpicks.
- Inside the house, wear shoes or non-slip slippers.
- Be careful when cutting your toenails, and never attempt to trim corns or calluses yourself.
- While outdoors, always wear shoes. Wear appropriate gloves for yard work or for using sharp tools.
- Ask your healthcare provider what other precautions you can take to stay as safe as possible while taking a blood thinner.
Summary
Xarelto and Eliquis are orally administered prescription blood thinners to prevent and treat blood clots. These drugs are considered safe, reliable, and vital in preventing DVT and PE.
While Xarelto and Eliquis are in the same class of drugs, they share some key differences, including their active ingredients, specific uses, and dosing guidelines.
Consult with your healthcare provider for more information about these medications and guidance on which drug is best for you.
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