Which is better for you, Xarelto or Eliquis?

If your doctor recently told you that you need a blood thinner and prescribed one for you, you may be searching online for “Eliquis vs Xarelto” to better understand your options. If you have atrial fibrillation (AFib), your doctor may have recommended Eliquis (apixaban) or Xarelto (rivaroxaban), two commonly prescribed blood thinners that help lower your risk of stroke and blood clots.

Both medications are newer blood thinners that can be used as alternatives to warfarin for some patients with nonvalvular atrial fibrillation. They are approved for several of the same conditions, including reducing the risk of stroke in people with atrial fibrillation (AFib). However, they are not exactly the same. Eliquis and Xarelto differ in how often you take them, their observed bleeding risk, and how much they may cost.

This guide explains how Eliquis and Xarelto compare in terms of effectiveness, safety, convenience, and cost. We’ll review what research studies have found, discuss the differences that may matter most in everyday life, and help you understand the questions to ask when talking with your doctor about which option may be right for you.

Key Takeaways

• Eliquis and Xarelto are both approved blood thinners for several adult conditions, including reducing the risk of stroke and systemic embolism in people with nonvalvular atrial fibrillation and treating prevent recurrent venous blood clots. Both medications also have pediatric uses for certain venous thromboembolic events, but their pediatric indications, weight-based dosing, formulations, and dosing schedules are not identical.

• One of the biggest differences between the two medications is dosing: Eliquis is usually taken twice daily, while Xarelto is typically taken once daily, and certain doses must be taken with food.

• Prescription costs can vary depending on the medication, strength, and quantity. Comparing prices can help you identify potential savings.

What Are DOACs & Factor Xa Inhibitors?

Before looking at the differences between Eliquis and Xarelto, it helps to understand why doctors often prescribe these medications instead of older blood thinners such as warfarin. Both belong to a group of blood thinners called direct oral anticoagulants (DOACs).

DOACs work faster and more predictably than warfarin. While warfarin affects several clotting factors and often requires regular blood tests, DOACs target specific clotting factors and generally do not require routine blood monitoring. This may make your treatment easier to manage and reduce the need for frequent blood test appointments.

Eliquis and Xarelto belong to a group of medications known as factor Xa inhibitors. Factor Xa is a protein that helps your body form blood clots. By blocking factor Xa, Eliquis and Xarelto make it harder for harmful blood clots to form. They can help lower the risk of clots associated with Deep vein thrombosis, pulmonary embolism, and prevent blood clots related to atrial fibrillation.

Because Eliquis and Xarelto work in similar ways and are often prescribed for many of the same conditions, patients frequently wonder whether one may be safer, more effective, or easier to take than the other. That’s exactly what we’ll look at next.

Could Eliquis or Xarelto Work for Your Condition?

Your doctor must select Eliquis or Xarelto, strength, your kidney function, age, weight, other medications, and bleeding risk.

Eliquis and Xarelto share several approved indications, including:

• They lower the risk of stroke in people with nonvalvular atrial fibrillation (AFib).
• Deep Vein Thrombosis can be treated.
• You can treat Pulmonary Embolism with these drugs.
• They prevent DVT or PE from coming back after initial treatment.
• They help prevent blood clots after hip replacement or knee replacement surgery.

The two medications also have important differences.

Xarelto has certain cardiovascular indications that Eliquis does not share. For example, Xarelto can be used in combination with low-dose aspirin to reduce the risk of major cardiovascular events in adults with coronary artery disease (CAD) or major thrombotic vascular events in adults with peripheral artery disease (PAD).

Both Eliquis and Xarelto are approved for pediatric indications, but their approved uses are not identical. The two medications differ in their pediatric age and weight requirements, formulations, and dosing schedules, so one should not be substituted for the other based only on pediatric availability.

Kidney function can affect dosing or suitability, but the way kidney function is considered differs between the two medications and depends on the condition being treated. Your doctor or pharmacist can determine which medication and dose is appropriate for your individual circumstances.

According to the CDC, up to 900,000 people in the U.S. may be affected by venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), each year. About one-third of people who experience a VTE may have another episode within 10 years.

Which Medication May Be Easier to Take Every Day?

When comparing Eliquis and Xarelto, one of the biggest practical differences is how often you take them and whether they need to be taken with food. While both medications are available in different strengths and forms, the dosing schedule may play an important role in which option fits more easily into your daily routine.

For adults, Eliquis is available as 2.5 mg and 5 mg tablets, while Xarelto is available in several tablet strengths, including 2.5 mg, 10 mg, 15 mg, and 20 mg. Both medications also have formulations and dosing options for certain pediatric patients. Eliquis has a pediatric formulation and weight-based dosing for its approved pediatric VTE indication, while Xarelto is available as an oral suspension and has weight-based pediatric dosing for its approved pediatric uses. Because the available formulations and dosing schedules differ, the appropriate product and dose depend on the child’s age, weight, condition, and specific prescription.

Another important difference is how you take each medication. You can take Eliquis with or without food. However, if you are prescribed the 15 mg or 20 mg dose of Xarelto, you should take it with food to help your body absorb the medication properly.

Dosing for Stroke Prevention in AFib

For Non-valvular atrial fibrillation (AFib), the usual Eliquis dose is 5 mg taken twice daily. Your doctor may prescribe a lower dose of 2.5 mg twice daily if you meet at least two of the following criteria:

• You are 80 years of age or older.
• You weigh 60 kg (about 132 pounds) or less.
• You have certain kidney function test results that show reduced kidney function (serum creatinine level greater than 1.5 mg/dL).

If you have non-valvular AFib and are prescribed Xarelto, the usual dose is 20 mg once daily with your evening meal.

For nonvalvular AFib, the usual Xarelto dose is 20 mg once daily with the evening meal. For patients with reduced kidney function within the range covered by the prescribing information, the recommended dose may be 15 mg once daily with the evening meal. The appropriate dose depends on kidney function and other clinical factors.

Dosing for DVT and PE Treatment

When Eliquis or Xarelto is used to treat deep vein thrombosis (DVT) or pulmonary embolism (PE), treatment begins with a higher-intensity regimen before transitioning to a longer-term dose. The dosing schedules are different for each medication.

For Eliquis, treatment of DVT or PE begins with 10 mg twice daily for 7 days, followed by 5 mg twice daily. After at least 6 months of treatment, Eliquis may be prescribed at 2.5 mg twice daily to reduce the risk of recurrent DVT or PE. Your doctor will determine whether extended treatment is appropriate based on your risk of another blood clot and your risk of bleeding.

For Xarelto, treatment of DVT or PE begins with 15 mg twice daily with food for the first 21 days, followed by 20 mg once daily with food. After at least 6 months of treatment, Xarelto may be reduced to 10 mg once daily to help reduce the risk of recurrent DVT or PE. Your doctor will determine whether continued treatment and the lower dose are appropriate for you.

Dosing After Hip or Knee Replacement Surgery

Eliquis and Xarelto are both approved to help prevent DVT and PE after hip or knee replacement surgery, but their labeled dosing schedules and treatment durations differ by medication and procedure.

For Eliquis, the recommended dose is 2.5 mg twice daily, with the first dose taken 12 to 24 hours after surgery. After hip replacement surgery, treatment is generally continued for 35 days. After knee replacement surgery, treatment is generally continued for 12 days.

For Xarelto, the recommended dose is 10 mg once daily, with the first dose taken 6 to 10 hours after surgery, once hemostasis has been established. After hip replacement surgery, treatment is generally continued for 35 days. After knee replacement surgery, treatment is generally continued for 12 days.

The appropriate medication, timing of the first dose, and duration of treatment should follow your surgeon’s or prescriber’s instructions.

Dosing for Children

Eliquis and Xarelto both have U.S. regulator-approved pediatric dosing for certain venous thromboembolic conditions, but their dosing schedules are not the same.

For Eliquis, the U.S. regulators-approved pediatric indication covers the treatment of VTE and reduction in the risk of recurrent VTE in patients from birth and older who have received at least five days of initial anticoagulant treatment. The recommended pediatric dose is based on body weight, with different dosing regimens used for different weight ranges. Eliquis also has a pediatric formulation intended to help provide the appropriate dose for children who may not be able to take the standard adult tablet regimen.

Xarelto also has U.S. regulators-approved pediatric uses for VTE treatment and prevention of recurrent VTE, with dosing based on the child’s body weight. Xarelto is available as an oral suspension for pediatric use, and its pediatric dosing schedule differs from that of Eliquis. Xarelto also has certain pediatric indications that Eliquis does not share, including use after the Fontan procedure in children with congenital heart disease.

Because the two medications have different pediatric indications, weight ranges, formulations, and dosing schedules, you should not assume that an Eliquis dose can be substituted for a Xarelto dose or vice versa. A child’s doctor should select the medication and calculate the appropriate dose based on the child’s condition, weight, age, and treatment history.

Do Eliquis and Xarelto Work Equally Well?

When comparing Eliquis and Xarelto, you may be wondering if one works better than the other. Both are anticoagulants used to help prevent strokes in people with nonvalvular atrial fibrillation (AFib).

Studies have shown that both Eliquis and Xarelto can reduce the risk of stroke and systemic embolism in people with nonvalvular AFib. However, the evidence comes from separate clinical trials rather than a direct head-to-head comparison of the two medications.

Researchers evaluated Eliquis in the ARISTOTLE trial, which compared Eliquis (apixaban) with warfarin in 18,201 people with nonvalvular AFib. The study found that Eliquis reduced the risk of stroke or systemic embolism by 21% compared with warfarin and resulted in fewer major bleeding events.

Xarelto was evaluated in the ROCKET AF trial, which compared Xarelto (rivaroxaban) with warfarin in 14,264 people with nonvalvular AFib. The study found that Xarelto was noninferior to warfarin for preventing stroke or systemic embolism, meaning it provided similar protection. The trial included many patients who had a higher risk of stroke, including those with previous stroke, heart failure, high blood pressure, diabetes, or older age.

Because ARISTOTLE and ROCKET AF were separate trials with different study designs and patient populations, their results cannot establish that Eliquis is superior or inferior to Xarelto. The findings show how each medication performed against warfarin in its respective trial, rather than providing a direct head-to-head comparison between Eliquis and Xarelto.

These separate clinical trials helped establish both Eliquis and Xarelto as important treatment options for people with AFib. As DOACs became more widely used, their use increased among people with AFib in the U.S. A study published in the Journal of the American Heart Association examined the use of DOACs among people with AFib during this period.

Based on clinical trial evidence, both medications are effective at helping reduce the risk of stroke and blood clots. However, effectiveness is only one part of the decision. You may also want to know whether one medication has a lower risk of bleeding than the other, which we’ll explore next.

Is One Blood Thinner Safer Than the Other?

Both Eliquis and Xarelto work well, but you may be wondering whether one is safer than the other. One of the biggest concerns with any blood thinner is bleeding, so it’s important to understand how these medications compare.

What Real-World Studies Show

Real-world observational studies have also compared apixaban (Eliquis) and rivaroxaban (Xarelto) in people with atrial fibrillation. Unlike randomized clinical trials, these studies examine what happens when medications are prescribed in routine medical practice rather than assigning participants randomly to a treatment group. This can provide useful information about how the medications perform among a broader range of people, including older adults and people with multiple health conditions.

A large systematic review and meta-analysis that included randomized trials and observational studies involving more than 3.9 million people with atrial fibrillation found that apixaban and rivaroxaban provided similar protection against stroke and systemic embolism. However, apixaban was associated with lower rates of major bleeding, intracranial bleeding, and death compared with rivaroxaban.

Importantly, these real-world findings show associations, not proof that one medication alone caused the difference. People who receive Eliquis may differ from those who receive Xarelto in ways that also affect their risk of bleeding or other outcomes. For example, prescribing patterns may differ according to a person’s age, kidney function, baseline bleeding risk, other medical conditions, or other medications. These differences can create confounding, meaning factors other than the blood thinner itself may partly explain the outcomes observed in an observational study.

Therefore, the lower bleeding rates observed with Eliquis in real-world research should not be interpreted as proof that Eliquis will be safer for every individual. The findings are useful when comparing the medications, but your doctor must consider your medical history, kidney function, bleeding risk, other medications, and the reason you need anticoagulation when choosing between them.

Even so, both medications can increase your risk of bleeding because they make it harder for your blood to form clots. While this helps lower your risk of serious complications such as stroke or pulmonary embolism, it is important to recognize which bleeding symptoms may be relatively minor and which require prompt or emergency medical attention.

Expected or Relatively Minor Bleeding

Like other anticoagulants, Eliquis and Xarelto can make you bruise more easily and may cause minor bleeding. You may notice bruising more easily than usual, occasional minor nosebleeds, or bleeding from your gums. These symptoms are not necessarily an emergency, but you should pay attention to bleeding that is unusual for you, becomes more frequent, or does not improve.

When to Contact Your Doctor

Contact your doctor or pharmacist promptly if you notice unusual or persistent bleeding, including:

• Frequent or prolonged nosebleeds
• Unusual or persistent bleeding from your gums
• Bruising that is unusually large, frequent, or unexplained
• Bleeding that lasts longer than usual or keeps recurring
• Unexplained weakness, dizziness, or tiredness

Do not automatically assume that unexplained tiredness or weakness is a routine side effect. These symptoms can sometimes occur with blood loss or anemia and should be evaluated by a healthcare professional.

When to Seek Emergency Medical Care

Some symptoms can indicate serious or potentially life-threatening bleeding and require immediate medical attention. Seek emergency medical care if you have:

• Bleeding that is severe or does not stop
• Vomiting blood or material that looks like coffee grounds
• Coughing up blood
• Red, pink, or brown urine
• Red or black, tarry stools
• Severe or unexplained weakness, dizziness, fainting, or lightheadedness
• A severe or unexplained headache
• Sudden confusion, trouble speaking, weakness or numbness, vision changes, or other new neurological symptoms
• A significant fall or head injury, even if you do not immediately notice bleeding

Do not stop taking Eliquis or Xarelto on your own because of bleeding or other side effects. Stopping an anticoagulant without medical guidance can increase your risk of blood clots and stroke. If you experience a medical emergency, follow the instructions of the emergency medical team.

What If the Cost of Eliquis or Xarelto Is Too High?

After looking up the price of Eliquis or Xarelto at your local pharmacy, you may have been surprised by how expensive these medications can be. Even when your doctor determines that one of these blood thinners is the right treatment for you, the monthly cost can be difficult to manage.

You may also be wondering why prices remain high when generic versions of apixaban (Eliquis) and rivaroxaban (Xarelto) have already been approved in the U.S. Remaining patent or exclusivity rights can prevent manufacturers from selling a generic even after it has been approved.

Your prescription cost may also depend on how your insurance plan works, that is if you have one. You may need to meet a deductible before your plan helps cover prescription costs. After that, you may still owe a copay (a fixed amount) or coinsurance (a percentage of the medication cost). Your plan may also place medications into different formulary tiers, which can affect how much you pay at the pharmacy.

If you’re enrolled in Medicare, retired, or living on a fixed income, these costs can place additional pressure on your budget. You may be tempted to delay refills or stretch out doses to save money, but doing so can reduce the protection these medications provide against stroke and blood clots.

One option is to compare prices with international pharmacies based in Canada.

Trying to decide whether Eliquis or Xarelto fits your budget? The comparison below shows U.S. prices alongside listed prices available through DoctorSolve.

How U.S. and Canadian Prices Compare

Prices can vary depending on the medication, strength, package size, insurance coverage, and purchasing channel. The table below compares listed prices for specific products and package quantities; it is not a comparison of clinically equivalent treatment regimens.

Product	Brand/Generic	Strength	Quantity	Approx. supply	U.S. price	DoctorSolve Price	Shipping fee
Eliquis	Brand	2.5 mg	56 tablets	28 days*	$514.26	$182.00	$9.95
Xarelto	Brand	2.5 mg	100 tablets	50 days*	$1,197	$245	$9.95
Apixaban	Generic	2.5 mg	60 tablets	30 days*	$94+	$58.95	$9.95
Rivaroxaban	Generic	2.5 mg	100 tablets	50 days*	$1,027	$72	$9.95

Shipping note: DoctorSolve charges a $9.95 U.S. shipping fee. Prescription drug prices include the prescribing fee and pharmacy dispensing fee.

These examples compare the listed product, strength, and package quantity through different purchasing channels. They are purchasing-price comparisons only and do not mean that Eliquis and Xarelto are clinically equivalent or interchangeable. In particular, Xarelto 2.5 mg is used in specific cardiovascular regimens and should not be interpreted as an equivalent substitute for an Eliquis regimen.

If lowering your prescription costs is a priority, ask your doctor or pharmacist whether the prescribed medication, strength, and quantity are appropriate for your condition, then compare prices for that same prescription at international pharmacy websites like Doctorsolve.

Current Pricing Through DoctorSolve

DoctorSolve is a prescription referral service that helps you access medications through international and Canadian pharmacy partners.

Before your next refill, compare your current out-of-pocket cost, insurance coverage, available generic options, and other legitimate prescription savings options. Coupons and assistance programs may provide temporary relief, but they can have eligibility requirements, changing terms, or expiration dates. For Americans seeking a long-term, reliable, and affordable option, DoctorSolve is the solution.

What Happens if You Have Serious Bleeding While Taking Eliquis or Xarelto?

Serious bleeding while taking a blood thinner requires urgent medical attention. Eliquis (apixaban) and Xarelto (rivaroxaban) affect factor Xa, an important part of the body’s clotting process. In an emergency, doctors may need to take steps to control the bleeding and address the effects of the anticoagulant.

Andexxa (andexanet alfa) was previously approved in the United States as a reversal agent for apixaban and rivaroxaban when reversal was needed because of life-threatening or uncontrolled bleeding. However, Andexxa is no longer commercially available in the United States. The manufacturer ended U.S. commercial sales on December 22, 2025, and the FDA subsequently listed the Andexxa indication as withdrawn.

The U.S. regulator reported safety concerns involving thromboembolic events, including serious and fatal outcomes, and concluded that the risks of Andexxa outweighed its benefits.

If you experience serious or uncontrolled bleeding while taking Eliquis or Xarelto, seek emergency medical care immediately. Do not try to manage or reverse the effects of the medication yourself. Hospital clinicians will determine the appropriate treatment based on factors such as which blood thinner you take, when you last took it, the severity and location of the bleeding, laboratory findings, and the emergency treatment options available at that facility.

It can be helpful to tell emergency medical staff the name of your blood thinner, the strength you take, your usual dose, and when you last took it. Keeping this information in your phone or carrying an up-to-date medication list can make it easier for the medical team to assess your situation quickly.

Can You Switch Between Eliquis and Xarelto?

Taking Eliquis or Xarelto and wondering whether switching to the other medication is an option? In some situations, a clinician may recommend switching from one anticoagulant to another because of side effects, insurance coverage, medication interactions, dosing convenience, or other clinical considerations.

When switching between anticoagulants, the timing of the first dose of the new medication depends on the medications involved, the reason for anticoagulation, the patient’s clinical circumstances, and the specific prescribing instructions. A clinician or pharmacist should provide instructions for when to stop the current medication and when to begin the new one.

For example, switching from Eliquis to Xarelto may involve starting Xarelto when the next dose of Eliquis would have been due, but this should not be treated as a universal timetable for every patient. The appropriate transition plan depends on the individual circumstances and should be confirmed by the prescribing clinician or pharmacist.

While switching may be appropriate in some situations, you should never stop, start, or change a blood thinner on your own. Missing doses can increase the risk of blood clots, while taking doses too close together or taking more than prescribed can increase the risk of bleeding. If you’re considering a change, talk with your doctor or pharmacist first so they can provide a transition plan appropriate for your treatment.

Frequently Asked Questions (FAQs)

Why Might a Clinician Prefer Eliquis for Some Patients?

A clinician may prefer Eliquis (apixaban) for some patients because comparative studies have found that apixaban is associated with lower rates of major bleeding and intracranial bleeding than rivaroxaban (Xarelto) in certain populations, while providing similar protection against stroke and systemic embolism. A large review involving more than 3.9 million people with atrial fibrillation reported these differences across randomized and observational evidence.

However, observational studies show associations rather than proving that Eliquis itself caused the lower bleeding rates. People prescribed Eliquis and Xarelto may differ in age, kidney function, baseline bleeding risk, other health conditions, other medications, and prescribing patterns. These factors can influence bleeding and other outcomes independently of the anticoagulant prescribed.

For this reason, Eliquis is not automatically the better or safer choice for everyone. A clinician may consider Eliquis when its overall benefits and risks fit a particular patient’s diagnosis, kidney function, age, other medications, adherence considerations, and bleeding risk.

What is the safest blood thinner with the fewest side effects?

There is no single blood thinner that is safest or causes the fewest side effects for everyone. The appropriate anticoagulant depends on factors such as your diagnosis, kidney function, age, medical history, other medications, ability to follow the dosing schedule, and bleeding risk.

For example, evidence in people with advanced chronic kidney disease or on dialysis, studies have found that apixaban may have similar or lower bleeding rates than warfarin in some populations. However, these findings do not mean apixaban is the safest blood thinner for every person with kidney disease or for every anticoagulation need.

What is the safest blood thinner for older adults?

There is no single blood thinner that is safest for every older adult. Some observational studies have associated apixaban (Eliquis) with lower rates of major bleeding, including intracranial bleeding, than rivaroxaban (Xarelto) in certain populations.

However, these observational findings cannot prove that apixaban itself caused the lower bleeding rates. Older adults prescribed anticoagulants such as Eliquis and Xarelto may differ in factors such as kidney function, baseline bleeding risk, other medical conditions, concurrent medications, and prescribing patterns. These differences can affect outcomes independently of the medication.

The safest option, therefore, depends on the individual. Your clinician should consider your diagnosis, kidney function, age, other medications, ability to follow the prescribed dosing schedule, and bleeding risk when deciding which anticoagulant is appropriate for you.

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