Xarelto vs Eliquis

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For patients with conditions like deep vein thrombosis (DVT), pulmonary embolism (PE), or atrial fibrillation, certain drugs that inhibit the clotting mechanism in the blood can help in preventing life-threatening complications. Xarelto and Eliquis are two such drugs that are often prescribed for these conditions. They each impact different aspects of the coagulation cascade, but both have anticoagulant effects in patients. Xarelto is a Factor Xa inhibitor which directly inhibits this key enzyme involved in blood clotting to prevent formation of clots. Eliquis, on the other hand, also belongs to the class of Factor Xa inhibitors and functions similarly to Xarelto by reducing clot-forming activity in blood platelets.

What is Xarelto?

Rivaroxaban (the generic name for Xarelto) was one of the first drugs in the direct oral anticoagulants (DOACs) class, which represented a significant advancement over the earlier anticoagulant medications such as warfarin. Rivaroxaban earned its FDA approval in 2011. Xarelto works by inhibiting Factor Xa, an enzyme important to blood clotting, thus preventing clots from forming. It is prescribed primarily for reducing risk of stroke and systemic embolism in patients with non-valvular atrial fibrillation or after hip or knee replacement surgery. Unlike warfarin which affects several enzymes involved in coagulation cascade, rivaroxaban has a selective influence on Factor Xa only resulting in it having fewer side effects than other older generation anticoagulants that have broader effects on multiple components of the coagulation system.

Apixaban (the generic name for Eliquis), another drug from DOACs class introduced shortly thereafter rivaroxaban's introduction, also functions by selectively inhibiting Factor Xa but differs slightly regarding dosing regimen and renal clearance among others. Both drugs are generally well tolerated; however each may be more suitable depending on individual patient factors.

What conditions is Xarelto approved to treat?

Xarelto and Eliquis are both approved for the treatment of several conditions related to blood clotting:

  • Prevention of stroke in people with atrial fibrillation (AFib that is not caused by a heart valve problem)
  • Treatment and prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE)
  • Prophylaxis or prevention of venous thromboembolism (VTE) in patients undergoing hip or knee replacement surgery

How does Xarelto help with these illnesses?

Xarelto helps manage the risk of blood clots by inhibiting a specific clotting factor in the body known as Factor Xa. It does this by directly binding to it, preventing it from initiating the cascade of reactions that lead to clot formation. Clotting factors are proteins in our blood that work together to stop bleeding via clot formation when we have an injury. However, excessive or inappropriate clotting can lead to serious conditions like deep vein thrombosis or stroke. By blocking Factor Xa, Xarelto can limit the chances of harmful clots forming and help patients manage their condition more effectively.

Conversely, Eliquis is also an anticoagulant that works similarly but has some unique characteristics which may make it preferable for certain individuals depending on their health status and lifestyle.

Both these medications are part of a newer class known as direct oral anticoagulants (DOACs), which provide more predictable effects and require less monitoring than older classes of anticoagulants like warfarin.

What is Eliquis?

Eliquis, known generically as apixaban, is a Factor Xa inhibitor that prevents blood clots by blocking the enzyme (Factor Xa) responsible for clotting. It was first approved by the FDA in 2012. As Eliquis does not inhibit Vitamin K like warfarin (another common anticoagulant), it doesn't require regular monitoring or dietary changes due to its mechanism of action. This absence of interaction with Vitamin K also means that Eliquis has fewer interactions with other medications and foods compared to warfarin.

Its side-effect profile is different from those drugs which act on Vitamin K - for instance, it may cause less bleeding than warfarin according to some studies. Still, like any anticoagulant medication, there's an increased risk of serious bleeding events while taking Eliquis.

The effects on Factor Xa can be beneficial for preventing strokes and systemic embolism in patients with nonvalvular atrial fibrillation and treating deep vein thrombosis (DVT) and pulmonary embolism (PE). Especially when these individuals do not respond well or cannot tolerate older generation anticoagulants like warfarin.

What conditions is Eliquis approved to treat?

Eliquis, a direct oral anticoagulant (DOAC), has been approved for the prevention and treatment of several conditions:

  • Prevention of stroke and systemic embolism in people with non-valvular atrial fibrillation
  • Treatment of deep vein thrombosis (DVT)
  • Prophylaxis of DVT, which may lead to pulmonary embolism (PE) in patients undergoing hip or knee replacement surgery.

How does Eliquis help with these illnesses?

Eliquis, like Xarelto, is a type of anticoagulant medication utilized to prevent the formation of blood clots in patients. These medications work by inhibiting specific proteins within the body's clotting process, thus reducing the risk of stroke and systemic embolism in individuals with nonvalvular atrial fibrillation. Eliquis specifically inhibits factor Xa, an enzyme that plays a crucial role in blood clotting. Its effect on this factor allows it to efficiently reduce the potential for strokes or heart attacks among high-risk patients. While similar to Xarelto in many ways, Eliquis has been shown through various studies to offer slightly lower bleeding rates—an important consideration when prescribing anticoagulants—making it sometimes preferred over Xarelto when considering patient-specific factors and responses.

How effective are both Xarelto and Eliquis?

Both rivaroxaban (Xarelto) and apixaban (Eliquis) are widely used oral anticoagulants that have transformed the management of conditions such as deep vein thrombosis (DVT), pulmonary embolism (PE), and stroke risk reduction in non-valvular atrial fibrillation. The FDA approved them within a few years of each other, with Xarelto coming to market in 2011 followed by Eliquis in 2012.

Rivaroxaban is a direct factor Xa inhibitor while apixaban inhibits both free and clot-bound factor Xa. Both drugs share similar safety profiles with lower incidences of major bleeding compared to their predecessor, warfarin. However, specific comparisons between them show some differences: for instance, the ARISTOTLE trial concluded that apixaban was superior to warfarin in preventing strokes or systemic embolisms and had less bleeding events than warfarin; meanwhile ROCKET-AF trial showed rivaroxaban was non-inferior to warfarin regarding prevention of strokes but had similar rates of major bleeding.

In terms of convenience, both medications offer the advantage over older alternatives like Warfarin due to simpler dosing regimens without the need for frequent INR checks. However, it's worth noting that these newer agents may not be suitable for patients with severe kidney impairment as they rely heavily on renal excretion.

Furthermore, a review published by The Lancet found no significant difference between apixaban and rivaroxaban regarding effectiveness or safety profile when treating DVT or PE. However patients taking Apixiban experienced fewer gastrointestinal bleeds which led researchers concluding that it could make Apixiban an attractive option for those at higher risk for GI bleeds.

While both drugs represent vital tools against coagulation-related health issues they do come with certain disadvantages over older therapies - namely lack availability of reversal agent until recently which can complicate treatment during emergency situations where prompt de-anticoagulation might be required such as acute brain hemorrhage or before urgent surgery.

abstract image of a researcher studying a bottle of drug.

At what dose is Xarelto typically prescribed?

Oral dosages of Xarelto usually range from 10-20 mg/day, depending on the condition being treated. For most people, a single daily dose is effective in preventing blood clots and stroke. On the other hand, Eliquis normally has an oral dosage of 2.5–5 mg taken twice daily. It's necessary to note that these dosages might be reduced for individuals with kidney problems or those taking certain medications. The maximum recommended dosage should not be exceeded under any circumstances as it can lead to excessive bleeding complications.

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At what dose is Eliquis typically prescribed?

Eliquis treatment is normally initiated at a dosage of 5 mg taken orally twice a day. For patients who are 80 years or older, have a body weight of 60 kg or less, or those with serum creatinine ≥1.5 mg/dL, the recommended dose is reduced to 2.5 mg taken orally twice daily. There's no need to increase the initial dose; however, it should be noted that consistent use is necessary for optimal results. If there appears to be no significant improvement in symptoms after several weeks of therapy at this level, consult your healthcare provider rather than adjusting the dosage yourself.

What are the most common side effects for Xarelto?

Common side effects of Xarelto and Eliquis include:

  • Easy bruising
  • Minor bleeding (such as a nosebleed, bleeding from cuts)
  • Lightheadedness or fainting
  • Tiredness or pale skin
  • Shortness of breath with mild exertion
  • Unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint spots under your skin
  • Heavy menstrual periods
  • Headache,
  • Dizziness,
  • Weakness,
  • Feeling like you might pass out.

Remember to seek immediate medical help if these symptoms persist. It's also important to note that both drugs have the potential for more serious side effects such as spinal blood clots following certain procedures which can lead to long-term paralysis. Always communicate any new or unusual symptoms to your healthcare provider promptly when taking either medication.

abstract image of a patient experiencing side effect

Are there any potential serious side effects for Xarelto?

While both Xarelto and Eliquis are anticoagulant medications, it's crucial to be aware of their possible side effects. In rare instances, some serious side effects can occur:

  • Unusual or prolonged bleeding
  • Signs of a severe allergic reaction such as hives, hard breathing, swelling in your face or throat
  • Unexpected bruising or bleeding from the nose or gums; red, pink or brown urine; black or bloody stools; coughing up blood; vomiting that looks like coffee grounds
  • Blurred vision
  • Severe headache
  • Dizziness/fainting spells
  • Weakness on one side of the body

In more dangerous cases symptoms might include:

  • Fast heartbeats,
  • Shortness of breath.
  • A lingering headache,
  • Confusion,
  • Slurred speech.

Should you experience any unusual symptoms while taking either Xarelto or Eliquis it is important to seek immediate medical attention.

What are the most common side effects for Eliquis?

While taking Eliquis, some individuals may experience the following side effects:

  • Nausea, minor stomach discomfort
  • Reduced blood clotting potential which might lead to excessive bleeding
  • Mild skin rash or itching
  • Easy bruising and increased tendency to bleed
  • Slight headache or dizziness
  • Fatigue and weakness Remember that while these side effects are possible, they do not occur in every individual. Always consult with your healthcare provider for personal advice concerning medication decisions.

Are there any potential serious side effects for Eliquis?

While Eliquis is generally well tolerated, it can sometimes cause serious side effects. Be vigilant for these signs and symptoms:

  • Signs of allergic reaction such as hives, itching, or rash
  • Difficulty breathing or swallowing due to a severe allergic reaction
  • Unexpected bleeding such as frequent nosebleeds, unusual bruising or discoloration on your skin, pink or brown urine, red or black stools
  • Swelling in the face or tongue
  • Unusual tiredness and weakness indicating anemia
  • Severe dizziness; fainting; rapid and irregular heartbeat If you notice any of these symptoms while taking Eliquis, contact your doctor immediately.

Contraindications for Xarelto and Eliquis?

Both Xarelto and Eliquis, like many other anticoagulant medications, could increase the risk of bleeding. If you notice any unusual or prolonged bleeding, such as frequent nosebleeds, bruising easily or blood in your urine or stool, please seek immediate medical attention.

Neither Xarelto nor Eliquis should be taken if you are currently using other anticoagulants (blood thinners) including heparin or warfarin unless explicitly directed by your physician. Always inform your doctor about all medications you are taking; switching between these medications without proper medical guidance can lead to dangerous interactions.

Moreover, before surgery or dental procedures it is necessary to stop intake of either drug temporarily under a doctor's advice due to increased risk of excessive bleeding during and after the procedure. It typically takes around 24-48 hours for these drugs to clear from the system sufficiently prior to a surgical intervention.

How much do Xarelto and Eliquis cost?

For the brand name versions of these drugs:

  • The price of 30 tablets (20 mg) of Xarelto averages around $470, which works out to approximately $15.66/day.
  • The price for a similar quantity and strength (5mg) of Eliquis is about $448, working out to approximately $14.93/day.

Thus, if you are taking one dose per day as commonly prescribed for anticoagulation therapy, Eliquis tends to be slightly cheaper than Xarelto on a per-day treatment basis. However please note that cost should not be your primary consideration in determining which of these blood thinners is right for you; efficacy and side-effect profiles also matter greatly.

As it stands currently, there are no generic versions available for either Xarelto (rivaroxaban) or Eliquis (apixaban), so their costs remain relatively high compared with medications available in generic form.

Popularity of Xarelto and Eliquis

Rivaroxaban, also known by its brand name Xarelto, and Apixaban, commonly known as Eliquis are two of the most frequently prescribed anticoagulants in the United States. They belong to a class of drugs called direct oral anticoagulants (DOACs) that have revolutionized treatment for conditions like atrial fibrillation and deep vein thrombosis.

In 2020, rivaroxaban was prescribed to approximately 3.6 million people in the USA. It accounted for about 35% of DOAC prescriptions in the US, making it one amongst the top choices for doctors when prescribing an oral anticoagulant.

Apixaban was prescribed to nearly 4.8 million people during the same period which accounts for around 47% of all DOAC prescriptions - making it slightly more popular than rivaroxaban among healthcare providers across America. Its popularity has been steadily increasing over recent years due to emerging data suggesting lower bleeding risks compared with other DOACs.


Both Xarelto (rivaroxaban) and Eliquis (apixaban) are widely used anticoagulants that serve to prevent blood clots, stroke, and systemic embolism in patients with non-valvular atrial fibrillation. They have been shown to be more effective than traditional warfarin treatment through a multitude of clinical trials and studies. Both drugs inhibit factor Xa in the coagulation cascade, preventing the formation of thrombin which is necessary for clot formation.

Eliquis is often preferred over Xarelto due to its dual-dose regimen as it provides slightly better protection against strokes and has less risk of causing gastrointestinal bleeding. However, these variances can differ based on individual patient characteristics such as renal function or weight.

Both drugs come in generic form providing significant cost savings especially for those patients who must pay out-of-pocket. Both medications require regular monitoring by healthcare professionals but do not demand frequent dosage adjustments like warfarin does.

Regarding their side-effect profiles, both medications generally present well-tolerated effects although bleeding complications remain notable risks associated with their usage. Patients should immediately seek medical help if they notice unusual bruising or persistent bleeding while taking either medication.