Xarelto vs. Eliquis: Which is better for blood clots?

In this article:

• What are the main differences between Eliquis and Xarelto?
• Conditions treated
• Efficiacy
• Cost and insurance coverage
• Side effects
• Interactions
• Warnings
• FAQs

In this article

• What are the main differences between Eliquis and Xarelto?
• Conditions treated
• Efficiacy
• Cost and insurance coverage
• Side effects
• Interactions
• Warnings
• FAQs

Eliquis and Xarelto are two brand-name medications used to prevent and treat various clotting disorders. Both drugs are oral anticoagulants and are subclassified as NOACs (novel oral anticoagulants) or DOACs (direct oral anticoagulants), based on their direct inhibition of the clotting protein factor Xa. Unlike Coumadin (warfarin), an older anticoagulant medication, patients taking Eliquis or Xarelto do not need regular blood tests to monitor levels. This convenience and their consistent blood-thinning action have made them popular amongst patients and healthcare providers. When choosing between Eliquis and Xarelto, the medical advice of your healthcare team is critical, but it can be helpful to enter into the conversation with more background knowledge.

RELATED: Are new blood thinners better than Coumadin (warfarin)?

What are the main differences between Eliquis and Xarelto?

Brand-name versions are typically the only option for Eliquis and Xarelto. Generic rivaroxaban is available as a 2.5 mg tablet only. Otherwise, no generic is available yet for either drug; however, a generic Eliquis is expected to be available in April 2028. Eliquis is made by Bristol-Myers Squibb in tablet form only, whereas Xarelto is made by Janssen Pharmaceuticals in both tablet and liquid suspension form. Both drugs are used by adults, but Xarelto is also used in children. Regardless of which DOAC is used, dosages vary by indication.

Main differences between Xarelto vs. Eliquis
	Xarelto	Eliquis
Drug class	Factor Xa inhibitor
Brand/generic status	Brand (except 2.5 mg rivaroxaban tablets)
What is the active ingredient?	Rivaroxaban	Apixaban
What form(s) does the drug come in?	Tablet, starter pack, oral suspension	Tablet, starter pack
What is the standard dosage?	Adults: 2.5 mg to 15 mg twice daily or 10 mg to 20 mg once daily Dosage varies by indication Children: Dosage varies by weight and indication	2.5 mg to 10 mg twice a day Dosage varies by indication
How long is the typical treatment?	Varies
Who typically uses the medication?	Adults and children	Adults
More information	What is Xarelto?	What is Eliquis?

Conditions treated by Xarelto and Eliquis

According to their drug labels, Eliquis and Xarelto have several indications that are the same—to reduce the risk of stroke and embolism in patients with nonvalvular atrial fibrillation (AFib, or irregular heartbeat), prevent deep vein thrombosis (DVT) in patients who have had hip or knee replacement, treat DVT, treat pulmonary embolism (PE), and to reduce the risk of recurrent DVT or PE following initial therapy. Both of the drugs are indicated for the following health conditions:

• Reduce the risk of stroke and embolism in the setting of nonvalvular AFib
• Prevent DVT in patients after hip or knee replacement surgery
• Treatment of DVT
• Treatment of PE
• Reduce the risk of recurrent DVT and PE following initial therapy

Additionally, Xarelto has several more indications, including FDA-approved indications in pediatric patients. The additional uses for Xarelto are the following:

• Prevent DVT and PE in acutely ill medical patients at risk of clotting complications and not at high risk of bleeding
• Reduce the risk of major cardiovascular events, in combination with aspirin, in patients with coronary artery disease (CAD)
• Reduce the risk of clotting complications in patients with peripheral arterial disease (PAD)
• Treatment of and reduction in the risk of recurrent DVT and PE in children from birth to 18 years after at least 5 days of injected anticoagulant therapy
• Prevention of clotting complications in pediatric patients with congenital heart disease after the Fontan surgical procedure

RELATED: How does Eliquis work for AFib?

Is Xarelto or Eliquis more effective?

Researchers published a review and meta-analysis of Eliquis and Xarelto for acute venous thromboembolism (VTE). They concluded that both drugs were similarly effective but that Eliquis may be safer. The patients treated with Xarelto experienced more bleeding, both major and minor. Another review in 2024 yielded similar findings.

A study in the Annals of Internal Medicine found that, in addition to bleeding more, people who took Xarelto for stroke and embolism prevention in AFib also had more ischemic (clots and strokes) events. Investigators in studies in the Journal of the American Medical Association (JAMA) and Heart Rhythm on older adults with AFib also found similar results—people in the rivaroxaban group (those who took Xarelto) had more clotting and bleeding events than those in the apixaban group (those who took Eliquis). 

Another study on patients with new AFib reviewed Eliquis, Xarelto, Pradaxa (another NOAC), and Coumadin (warfarin, an older anticoagulant). The authors concluded that Eliquis had the most favorable efficacy, safety, and patient compliance.

A 2022 trial from the University of Pennsylvania studied patients with atrial fibrillation and associated valvular heart disease. The study concluded that compared with Xarelto, Eliquis decreased the risk of blood clots by almost half. 

Sometimes it can be stressful to think about what the best drug for you is, especially with so many advertisements as well as opinions from family and friends. However, it’s best to remember that the best drug for you can only be determined by your healthcare provider, who can take into account the full picture of your medical condition(s), medical history, and other medications you take that could interact with Eliquis or Xarelto.

RELATED: Eliquis vs. warfarin

Coverage and cost comparison of Xarelto vs. Eliquis

Xarelto and Eliquis are typically covered by insurance and Medicare prescription plans, but the copays vary widely. 

A one-month supply (60 tablets of 5 mg) of Eliquis costs about $810 without insurance. However, you can use a SingleCare card to purchase Eliquis for less than $490.

A one-month supply (60 tablets of 2.5 mg) of Xarelto costs about $820 without insurance. You can use a SingleCare coupon to purchase Xarelto for just over $370 for 30, 20 mg tablets.

	Xarelto	Eliquis
Typically covered by insurance?	Yes	Yes
Typically covered by Medicare?	Yes	Yes
Cost without insurance	$820 for 60, 2.5 mg tablets	$810 for 60, 5 mg tablets
Lowest SingleCare price	$370 for 30, 20 mg tablets	$490 for 60, 5 mg tablets
SingleCare coupons	Xarelto coupons	Eliquis coupons

Prescription drug prices often change. These are the most accurate medication prices at the time of publishing. Click the coupon buttons to see updated drug prices.

RELATED: Get the SingleCare discount card

Common side effects of Xarelto vs. Eliquis

The most common side effects of Eliquis and Xarelto are related to bleeding, such as nosebleeds, contusions (bruising), blood in the urine, or bleeding gums. The incidence of bleeding side effects can vary. Less commonly, bleeding can be serious or even life-threatening, such as intracranial or gastrointestinal hemorrhage.

Other common side effects that may occur with Eliquis include nausea and anemia.

Side effects of Xarelto include the following: 

• Bleeding
• Back and abdominal pain
• Itching
• Fatigue
• Anxiety
• Depression
• Insomnia
• Dizziness

Eliquis can cause adverse effects such as:

• Bleeding
• Nausea or vomiting
• Anemia
• Liver enzyme elevation
• Headache

In rare cases, a serious allergic reaction to either medication may occur. If symptoms such as hives, difficulty breathing, or swelling of the face, lips, tongue, or throat occur, get emergency medical help right away. 

This is not a complete list of side effects. Consult your healthcare provider for more information on the adverse reactions of Eliquis and Xarelto.

Drug interactions for Xarelto and Eliquis

Eliquis and Xarelto interact with certain drugs that are metabolized by the same enzyme. When enzyme inhibitor drugs are used with Eliquis or Xarelto, the levels of Eliquis or Xarelto in your body would increase, which would put you at increased risk for bleeding. If you have to take this combination of drugs, it is likely that your healthcare provider will change your Eliquis or Xarelto while on both medications. Examples of these interacting drugs include Nizoral (ketoconazole and Paxlovid (nirmatrelvir and ritonavir). 

On the other hand, when enzyme inducers are taken with Eliquis or Xarelto, there is an interaction where those drugs make Eliquis or Xarelto metabolize faster, and you may not get enough of the Eliquis or Xarelto dose. As a result, the formation of blood clots or a stroke could ensue. Examples include rifampin, Tegretol (carbamazepine), Dilantin (phenytoin), and the supplement St. John’s wort. 

Using Eliquis or Xarelto with other anticoagulants, antiplatelet drugs, NSAIDs (nonsteroidal anti-inflammatory drugs), or certain antidepressants may increase the risk of bleeding. However, for some indications, Xarelto should be taken with a low dose of aspirin or another antiplatelet drug. Your healthcare provider will tell you whether you should take any of these combinations. 

This is not a full list of drug interactions. Consult your healthcare provider for more information about drug interactions and how they may affect you. Before taking Eliquis or Xarelto, tell your healthcare provider about all the medications you take, including prescription and OTC drugs, vitamins, and supplements. 

Warnings of Xarelto and Eliquis

Eliquis and Xarelto have a boxed warning, also known as a black box warning, which is the strongest warning required by the U.S. Food and Drug Administration (FDA). The warnings state that discontinuing Eliquis or Xarelto prematurely increases the risk of a clotting event, and in addition, dangerous epidural or spinal bleeding and hematomas can occur in patients who are receiving spinal anesthesia or spinal puncture.

Other warnings outline that bleeding may occur and could be serious or potentially fatal. Furthermore, using Eliquis or Xarelto with certain drugs (anticoagulants, antiplatelet drugs, NSAIDs, SSRI or SNRI antidepressants) increases the risk of bleeding. The drug labels warn that patients with active bleeding should seek emergency medical attention and note that a reversal agent is available to reverse the effects of factor Xa inhibition.

Safety messaging also highlights that Eliquis or Xarelto are not recommended in patients with prosthetic heart valves and are not recommended as an alternative to heparin for initial treatment of PE patients who have hemodynamic instability (shock or heart failure). The labels clarify that these drugs should not be used in patients with triple-positive antiphospholipid syndrome (APS) due to an increased risk of clotting.

Certain health conditions could be problematic. Patients with chronic liver disease or chronic kidney problems must talk to their healthcare provider before taking Eliquis or Xarelto. There is limited data on the use of Eliquis or Xarelto in pregnancy, and using either drug may increase the risk of bleeding during both pregnancy and delivery, increase the risk of bleeding in the fetus/newborn, and increase the risk of epidural or spinal hematoma if an epidural is used for anesthesia during labor and delivery. Consult your OB-GYN about the use of Eliquis or Xarelto during pregnancy. Generally, the drug is only used if benefits outweigh risks (for example, in certain high-risk pregnancies) and with careful monitoring. If you are already using Eliquis or Xarelto and find out that you are pregnant, consult your OB-GYN for guidance.

RELATED: What foods to avoid while on Eliquis

Frequently asked questions about Eliquis vs. Xarelto

Are Eliquis and Xarelto the same?

Eliquis and Xarelto are both known as direct factor Xa inhibitors. They are similar, but not exactly the same. One of the main differences is that Xarelto has several more indications, including some specific uses for children and adolescents, while Eliquis is not FDA-approved for use in this age group. Xarelto is typically taken once a day, while Eliquis is taken twice daily. Other similarities and differences are outlined above. Other factor Xa inhibitors include Arixtra (fondaparinux) and Savaysa (edoxaban). Pradaxa (dabigatran) is a direct thrombin inhibitor with similar uses.

RELATED: Eliquis alternatives

What is the most significant difference between Xarelto and Eliquis side effects?

A clinical trial that studied Xarelto in older adults found that the risk of bleeding increases with age, which is a concern for older adults. On the other hand, Eliquis also can have a side effect of bleeding, but studies show that it is not age-related. 

Is Eliquis or Xarelto better?

Studies (see above for details) have shown that Eliquis and Xarelto are similarly effective, or that Eliquis may be slightly more effective. Eliquis seems to have a lower risk of bleeding than Xarelto. For example, this was seen in a clinical study on gastrointestinal bleeding in patients with atrial fibrillation. Ask your doctor if Eliquis or Xarelto is appropriate for you.

Can I use Eliquis or Xarelto with alcohol?

Alcohol can thin the blood. If you take Eliquis or Xarelto and drink alcohol, this could increase the risk of bleeding. Also, alcohol can aggravate certain medical conditions. You can ask your healthcare provider if it is safe to drink, and how much, with the medication you take and the medical condition(s) you have.

Is Xarelto cheaper than Eliquis?

For a one-month supply, the price of Xarelto and the price of Eliquis are very similar. On average, Xarelto costs $820 without insurance for 60, 2.5 mg tablets; Eliquis costs $820 without insurance for 60, 5 mg tablets. The twice-daily 2.5 mg tablets of Xarelto are used for cardiovascular event risk reduction in patients with pre-existing vascular disease, whereas Xarelto once-daily 20 mg tablets are used for blood clot treatment, similar to Eliquis 5 mg tablets, which are taken twice daily. The monthly price of Xarelto with a SingleCare coupon is $370 for 30, 20 mg tablets; the price of Eliquis with a SingleCare coupon is $490 for 60, 5 mg tablets.

Can you switch between Eliquis and Xarelto?

While these drugs should not be taken together, in some cases, there may be a reason to switch from Eliquis to Xarelto, or Xarelto to Eliquis. This switch should only be done under the medical advice of the healthcare provider, who will also give dosing instructions on how to switch medications.