Blood thinners, also known as anticoagulants, are essential for preventing dangerous blood clots that can lead to stroke, deep vein thrombosis (DVT), and pulmonary embolism (PE). The most commonly prescribed anticoagulants are Xarelto (rivaroxaban) and Apixaban (Eliquis). These medications are direct oral anticoagulants (DOACs) and inhibit Factor Xa, a key protein in blood clot formation.
While both drugs are effective, they have differences in dosing, cost, side effects, and suitability for different medical conditions. If you’re trying to decide between Xarelto vs Apixaban, this guide will help you understand how they compare and which may be the right choice.
What Are Xarelto and Apixaban Used For?
Xarelto and Apixaban are prescribed to prevent and treat blood clots, but their specific uses vary slightly.
Conditions Treated by Xarelto and Apixaban
- Stroke Prevention in Atrial Fibrillation (AFib) – Prevents clots that could travel to the brain.
- Deep Vein Thrombosis (DVT) – Treats and prevents clots in the legs.
- Pulmonary Embolism (PE) – Treats and prevents dangerous lung clots.
- Post-Surgical Blood Clot Prevention – Used after knee or hip replacement surgery.
Key Differences in Usage
- Xarelto is FDA-approved for coronary artery disease (CAD) and peripheral artery disease (PAD), whereas Apixaban is not.
- Apixaban is often preferred for patients with kidney disease due to its more predictable clearance by the body.
If you’re considering Xarelto alternatives, Apixaban (Eliquis) is a top choice due to its similar mechanism of action.
Xarelto vs. Apixaban: Dosing Differences
One of the most significant differences between Xarelto and Apixaban is how often they are taken.
Xarelto Dosage
- For stroke prevention in AFib: 20 mg once daily with food.
- For DVT/PE treatment: 15 mg twice daily for 21 days, then 20 mg once daily.
- For post-surgical clot prevention: 10 mg once daily.
Apixaban Dosage
- For stroke prevention in AFib: 5 mg twice daily.
- For DVT/PE treatment: 10 mg twice daily for 7 days, then 5 mg twice daily.
- For post-surgical clot prevention: 2.5 mg twice daily.
Key Differences in Dosing
- Xarelto is taken once daily, while Apixaban is taken twice daily for most conditions.
- Apixaban has a lower risk of significant bleeding and may be preferred for elderly patients.
- Xarelto must be taken with food for proper absorption, while Apixaban can be taken with or without food.
If you prefer a once-daily medication, Xarelto may be more convenient. However, some patients find twice-daily Apixaban more effective at maintaining steady anticoagulation levels.
Apixaban vs. Xarelto Cost: Which Is More Affordable?
Apixaban vs Xarelto cost varies depending on insurance coverage, location, and available discounts.
Average Monthly Costs Without Insurance
- Xarelto: $500–$600 per month
- Apixaban (Eliquis): $500–$600 per month
Factors Affecting Cost
- Generic Versions: Apixaban has a generic available in some regions, making it cheaper than Xarelto in some instances.
- Insurance Coverage: Some insurance plans cover one medication more favorably than the other.
- Manufacturer Coupons & Assistance Programs: Xarelto and Apixaban offer patient savings programs to reduce costs.
If affordability is a concern, talk to your doctor about cost-saving options or explore alternatives to Eliquis and Xarelto based on your insurance plan.
Side Effects: Xarelto vs Apixaban
Both medications have similar side effects since they work similarly, but there are some differences in risk levels.
Common Side Effects of Both Medications
- Mild bleeding (gums, nosebleeds, easy bruising)
- Fatigue or dizziness
- Nausea or mild stomach discomfort
Serious Side Effects to Watch For
- Uncontrolled bleeding – Both drugs increase the risk of severe bleeding events, but Apixaban has a slightly lower risk of major bleeding than Xarelto.
- Blood in urine or stools – A sign of internal bleeding that requires medical attention.
- Severe headaches or dizziness may indicate a brain bleed (rare but serious).
Which Has a Lower Risk of Bleeding?
- Apixaban is generally considered safer for patients at higher risk of significant bleeding (especially in older adults or those with kidney disease).
- Xarelto may have a slightly higher risk of stomach bleeding, particularly in patients with a history of gastric ulcers or digestive issues.
If you are at risk of severe bleeding, your doctor may prefer Apixaban over Xarelto due to its lower bleeding risk profile.
Alternatives to Eliquis and Xarelto
If you’re looking for Xarelto alternatives or alternatives to Eliquis, there are other blood thinners available:
- Warfarin (Coumadin) – Older but still widely used. Requires frequent blood monitoring and dietary restrictions.
- Dabigatran (Pradaxa) – Another DOAC that works slightly differently but is also effective for preventing blood clots.
- Edoxaban (Savaysa) – A DOAC that may be an option for some patients, though it is less commonly prescribed.
Your doctor will help determine the best anticoagulant based on your health condition, risk factors, and insurance coverage.
Choose Xarelto If:
- You prefer a once-daily dose for convenience.
- You need protection for coronary or peripheral artery disease (Apixaban is not FDA-approved for these).
- You can take it with food to ensure proper absorption.
Choose Apixaban If:
- You prefer twice-daily dosing for more consistent anticoagulation.
- You have a higher risk of bleeding and need a safer option.
- You have kidney disease and need medication with predictable elimination.
Conclusion
Xarelto and Apixaban are highly effective blood thinners that help prevent strokes, DVT, and PE. Choosing the right one depends on your medical history, dosing preference, cost considerations, and bleeding risk factors.
While Xarelto is taken once daily and is FDA-approved for more conditions, Apixaban may be safer for patients at high risk of bleeding. When considering the cost of Apixaban vs. Xarelto, Apixaban may offer a generic option in some cases, making it more affordable. Ultimately, your doctor can help determine the best option for your health needs.
Frequently Asked Questions (FAQs)
Which is better: Xarelto or Apixaban?
Both are effective, but Apixaban is preferred for patients at higher risk of bleeding, while Xarelto offers once-daily dosing and more coverage for cardiovascular conditions.
Are there alternatives to Eliquis and Xarelto?
Yes. Alternatives are Warfarin, Dabigatran (Pradaxa), and Edoxaban (Savaysa). Warfarin requires frequent blood monitoring, while the others are newer DOACs.
Does Xarelto or Apixaban have fewer side effects?
Both medications have similar side effects, but Apixaban has a lower risk of significant bleeding, making it the safer option for some patients.
Can I switch from Xarelto to Apixaban?
Switching between anticoagulants should only be done under medical supervision to avoid clotting or bleeding risks.
