Key takeaways
Eliquis and Xarelto are both FDA-approved blood thinners to prevent complications from blood clots but differ in dosages.
Switching from Xarelto to Eliquis doesn’t require tapering but should be timed carefully to avoid gaps in treatment.
Studies show Eliquis may lower the chance of stroke and major bleeding compared to Xarelto.
Xarelto (rivaroxaban) and Eliquis (apixaban) are both anticoagulants (blood thinners) used for similar purposes. Although they belong to the same drug class, they vary in ways such as dosage, potential benefits, and risks.
If you’ve been taking Xarelto and experience bleeding events often, your healthcare provider may recommend Eliquis. You might also be recommended Eliquis based on newer studies suggesting that Eliquis may be more effective than Xarelto. Recent research suggests that people switching from Xarelto to Eliquis may have a significantly reduced risk of stroke compared to staying on Xarelto.
Are Xarelto and Eliquis approved for the same thing?
Xarelto is an oral anticoagulant that belongs to a drug class called direct oral anticoagulants (DOACs). The Food and Drug Administration (FDA) has approved Xarelto for several uses, including the prevention of stroke in non-valvular atrial fibrillation (NVAF) and the treatment or prevention of venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE). It’s also used to reduce the risk of blood clots in people who have had knee or hip replacement surgery.
Eliquis is also a DOAC that works as a factor Xa inhibitor, similar to Xarelto. The FDA has approved Eliquis for the same conditions as Xarelto, including stroke prevention in patients with AFib, treatment and prevention of DVT and PE, and prevention of blood clots after hip or knee replacement surgery. Like Xarelto, it’s recommended for people with prosthetic heart valves.
These medications are similar in their approved uses but differ in dosing schedules, potential efficacy, and side effects. Xarelto is typically taken once daily, while Eliquis requires twice-daily dosing. Both are alternatives to older blood thinners like vitamin K antagonists (warfarin) and don’t require the regular blood monitoring that those medications do.
What are the benefits of switching from Xarelto to Eliquis?
Some people may experience advantages when changing from Xarelto to Eliquis. Clinical trials have shown differences between these medications that might benefit some individuals, especially when it comes to the risk of blood clots and bleeding.
Decreased risk of blood clots and related events
Eliquis has been shown to be slightly more effective in preventing blood clots than Xarelto in some patient populations. Studies suggest both medications work well, but Eliquis might offer improved protection for certain people.
For patients with atrial fibrillation, Eliquis demonstrated a 21% reduction in stroke or systemic embolism compared to warfarin, while Xarelto showed a 12% reduction in similar trials. One study directly compared Eliquis and Xarelto in older adults and found that the risk of stroke and blood clots was significantly higher in those taking Xarelto than in those taking Eliquis. The difference could be meaningful for high-risk patients.
Bristol Myers Squibb, the maker of Eliquis, has emphasized these benefits in its clinical data. The dosing schedule of Eliquis (twice daily) may provide more consistent blood-thinning effects than Xarelto’s once-daily dosing.
Lower risk of bleeding
One of the most significant benefits of switching to Eliquis is the potentially lower risk of major bleeding as a side effect. Clinical trials show Eliquis users experienced fewer bleeding complications compared to those taking Xarelto.
In one study, researchers found that patients with atrial fibrillation taking Xarelto had a higher risk of major bleeding than those taking Eliquis. Specifically, the risk of major bleeding was about 89% higher for those on Xarelto. For older adults on Medicare with gastrointestinal bleeding risks or those concerned about bleeding risk during surgical prophylaxis, the safety profile of Eliquis might be preferable.
Xarelto vs. Eliquis comparison chart |
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Xarelto | Eliquis | |
Standard adult dosage | 10 to 20 mg once daily | 2.5 to 5 mg twice daily |
Major ischemic events rate | 8.6 cases per 1,000 people each year | 7.6 cases per 1,000 people each year |
Serious bleeding rate | 7.5 cases per 1,000 people each year | 5.9 cases per 1,000 people each year |
Nonfatal serious bleeding rate | 39.7 cases per 1,000 people each year | 18.5 cases per 1,000 people each year |
Typically covered by insurance? | Yes | Yes |
Average retail cost for a 30-day supply* | $821 for 60, 2.5 mg tablets of brand-name Xarelto | $813 for 60, 5 mg tablets of brand-name Eliquis |
Average cost with a SingleCare coupon* | $193 for 60, 2.5 mg tablets of generic rivaroxaban | $488 for 60, 5 mg tablets of brand-name Eliquis |
*Average cost at time of publication. Drug prices fluctuate and vary by location.
How to switch from Xarelto to Eliquis
Switching from Xarelto to Eliquis is relatively straightforward. Unlike some medications, there’s no need to taper or gradually adjust the dose when making the switch.
However, timing is still important when starting Eliquis after the discontinuation of Xarelto. When making this change, you start taking Eliquis at the time when your next dose of Xarelto would have been taken. Doing so ensures you continue to get the blood-thinning benefits without interruption. Eliquis is generally taken two times a day, so be sure to set up reminders to take an additional dose compared to your once-daily routine with Xarelto.
The dosage you start Eliquis with will depend on what you were taking Xarelto for. The following table can give you an idea of what to expect when switching dosages.
Xarelto to Eliquis dose conversion chart |
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Use | Xarelto dosage | Eliquis dosage |
Nonvalvular atrial fibrillation | 15 or 20 mg once daily with food | 5 mg twice daily |
Prevention of DVT following hip or knee replacement surgery | 10 mg once daily with or without food | 2.5 mg twice daily |
Treatment of DVT and PE | 15 mg twice daily for 21 days, then 20 mg once daily with food | 10 mg twice daily for one week, then 5 mg twice daily |
While Xarelto is typically recommended to be taken with food, Eliquis can be taken with or without food. Some patients might need a lower dose of Eliquis (2.5 mg twice daily) if they meet at least two of these criteria:
- Age of 80 years or older
- Body weight of 60 kg (132 lbs) or less
- Serum creatinine of 1.5 mg/dL or higher
Always consult your healthcare provider first. Never switch blood thinners on your own. Your healthcare provider will give you specific instructions based on your medical condition.
Side effects from stopping Xarelto and starting Eliquis
Some people may experience different side effects when switching between these medications. As blood thinners, these medications can cause similar side effects, mostly related to bleeding. While using Xarelto or Eliquis, you might experience increased bruising and prolonged bleeding times.
Seek immediate help from your healthcare provider or get emergency help if you experience the following:
- Vomiting blood or having vomit that resembles coffee grounds
- Red or black stools that appear tar-like
- Presence of red, pink, or brown urine
- Coughing up blood or blood clots
- Unusual bleeding from the gums
- Frequent nosebleeds
- Heavier than normal menstrual or vaginal bleeding
- Blood loss that is uncontrollable or severe
- Unexpected pain, swelling, or joint pain
- Headaches, dizziness, or feelings of weakness
Although both medications carry a risk of bleeding, neither drug requires regular INR monitoring like warfarin does. This makes the transition easier from a hematology perspective.
Both medications can interact with other drugs, which might increase the chances of side effects like bleeding. Other medications can also make these blood thinners less effective, which could raise the risk of blood clots.
Xarelto and Eliquis can interact with the following types of drugs:
- Inhibitors of CYP3A4 and P-gp: These drugs, which include ketoconazole and ritonavir, can increase the risk of bleeding when taken with Xarelto or Eliquis.
- Inducers of CYP3A4 and P-gp: Medications like rifampin and carbamazepine may reduce the effectiveness of Xarelto and Eliquis, increasing the risk of blood clots.
- Other anticoagulants and antiplatelet agents: Using Xarelto or Eliquis with drugs like aspirin or unfractionated heparin can increase the chances of bleeding.
How to minimize Eliquis side effects
There are different ways to reduce the risk of bleeding with Eliquis. General tips to minimize Eliquis side effects include:
- Take Eliquis exactly as prescribed.
- Keep all follow-up appointments with your healthcare provider to monitor your response.
- Create a reminder system, like phone alarms, or use pill organizers to help you remember and manage your doses.
- Avoid activities with a high risk of injury or bleeding.
- Tell all healthcare professionals you’re taking Eliquis before any procedures.
- Wear a medical alert bracelet or carry a card identifying that you take Eliquis.
During treatment with Eliquis, it may be helpful to take notes about any side effects you experience. This information can be valuable when talking with your healthcare provider. Pay attention to unusual bleeding or bruising, and contact your healthcare provider immediately if you notice blood in your urine, black stools, or coughing up blood.
Always consult a healthcare provider about other medications you take, including prescription drugs, over-the-counter medicines, and herbal supplements, before starting treatment with a blood thinner.
Can you take Eliquis and Xarelto together?
Taking Eliquis and Xarelto together is not recommended because both medicines work in similar ways to prevent blood clots. Using them at the same time could greatly increase your risk of serious bleeding problems. It would essentially be like doubling up on the same type of medication.
If you are taking one of these medications and are thinking about switching to the other, it can be done, but only with a healthcare provider’s guidance. You should never start, stop, or change your medication without talking to your healthcare provider first. Your healthcare provider can offer medical advice on whether switching is an effective and safe option for you.
- Xarelto highlights of prescribing information, Food and Drug Administration (2023)
- Eliquis highlights of prescribing information, Food and Drug Administration (2025)
- Clinical and pharmacological effects of apixaban dose adjustment in the ARISTOTLE trial, Journal of the American College of Cardiology (2020)
- Comparative effectiveness of rivaroxaban in the treatment of nonvalvular atrial fibrillation, Journal of Comparative Effectiveness Research (2017)
- Comparative effectiveness and safety of rivaroxaban with other oral anticoagulants in older adults with nonvalvular atrial fibrillation: population-based analysis in response to updated Beers Criteria, Journal of Thrombosis and Haemostasis (2025)
- Retrospective observational study assessing real-world clinical impact of switching or continuing Eliquis® or rivaroxaban presented at the European Society of Cardiology (ESC) Congress 2023, Bristol Myers Squib, (2023)
- Rivaroxaban versus apixaban for stroke prevention in atrial fibrillation: an instrumental variable analysis of a nationwide cohort, Circulation: Cardiovascular Quality and Outcomes (2020)
- Association of rivaroxaban vs apixaban with major ischemic or hemorrhagic events in patients with atrial fibrillation, JAMA (2021)
- Eliquis package insert, Bristol-Myers Squibb (2021)
- Apixaban, StatPearls (2024)
- What are the potential side effects of anticoagulants?, National Blood Clot Alliance