Are Xarelto and Eliquis the same? A Detailed Comparison of These Anticoagulants

October 11, 2025 •

3 min read

According to the CDC, anticoagulant use is a leading cause of adverse drug event-related hospitalizations in older adults, making the choice of medication critical. While both Xarelto and Eliquis are popular blood thinners, are Xarelto and Eliquis the same? They are not, and understanding their distinct profiles is essential for making informed treatment decisions.

Quick Summary

This comparison details the differences between anticoagulants Xarelto (rivaroxaban) and Eliquis (apixaban), including their dosing schedules, bleeding risk, approved uses, cost, and reversal agents.

Key Points

Not the Same Medication: While both are Factor Xa inhibitors (blood thinners), Xarelto (rivaroxaban) and Eliquis (apixaban) are distinct medications with different dosing schedules and safety profiles.
Twice vs. Once Daily Dosing: Eliquis is typically taken twice a day, while Xarelto is usually a once-daily medication, which can influence patient preference and compliance.
Potential for Lower Bleeding Risk with Eliquis: Multiple studies suggest that Eliquis may be associated with a lower risk of major bleeding compared to Xarelto, especially in older adults with atrial fibrillation.
Different Approved Uses: Xarelto has a broader range of approved uses, including specific pediatric uses and certain cardiovascular conditions, while Eliquis is approved only for adults.
Consideration for Kidney Function: Eliquis is often preferred for patients with moderate to severe kidney impairment because its clearance is less dependent on kidney function compared to Xarelto.
Identical Reversal Agent: The effects of both drugs can be reversed by the same specific antidote, Andexxa (andexanet alfa), in cases of severe bleeding.

Understanding Factor Xa Inhibitors

At their core, Xarelto (rivaroxaban) and Eliquis (apixaban) are both direct oral anticoagulants (DOACs). They work by inhibiting Factor Xa, an enzyme vital to blood clotting, to prevent new clots. Unlike warfarin, they don't require dietary restrictions or routine blood monitoring. While they share a mechanism, they have key differences.

Key Differences: Xarelto vs. Eliquis

Dosing and Administration

Eliquis is consistently taken twice daily, while Xarelto is usually taken once a day, although some uses require twice-daily dosing. For AFib, Xarelto is taken once daily with the evening meal, while Eliquis is taken twice daily without regard to food.

Approved Indications

Both drugs are approved for reducing stroke/systemic embolism risk in non-valvular AFib, treating DVT and PE, and preventing DVT and PE after hip or knee surgery. Xarelto also has additional uses, including preventing major cardiovascular events in patients with CAD or PAD when used with aspirin, and is approved for some pediatric patients, unlike Eliquis.

Bleeding Risk and Safety Profile

Bleeding is the most common side effect for both. Studies suggest Eliquis may be linked to a lower risk of major bleeding than Xarelto, especially in older adults with AFib. Both carry a boxed warning about clotting risk if treatment is stopped early.

Impact on Kidney Function

Eliquis may be better for those with moderate to severe kidney issues as it's less reliant on kidney function for elimination. Xarelto might need dose adjustments for impaired kidney function.

Cost and Generic Availability

Both have historically been expensive. A generic Eliquis (apixaban) is approved but delayed by patents until around 2026-2028. A generic 2.5 mg Xarelto (rivaroxaban) is available as of 2025, but generics for other strengths are under patent. Cost varies with insurance.

Reversal Agents

Andexxa (andexanet alfa) can reverse the effects of both in severe bleeding by neutralizing the Factor Xa inhibitors.

Comparison Table: Xarelto vs. Eliquis


Feature	Xarelto (rivaroxaban)	Eliquis (apixaban)
Dosing Frequency	Once daily for most conditions (some require twice daily)	Twice daily
Bleeding Risk	Potentially higher risk of major bleeding in some studies, especially in older adults	May have a lower risk of major bleeding
Impact on Kidneys	May require dose adjustment for impaired kidney function	Often preferred for moderate-to-severe kidney issues
Approved Uses	Broader range of indications, including pediatric use and certain cardiovascular conditions	Approved for similar core conditions in adults only
Generic Availability	2.5 mg strength generic available as of 2025; others under patent	Generic approved, but commercial availability delayed by patent until 2026 or 2028
Food Requirement	Requires food intake for certain uses (e.g., AFib, DVT/PE)	Can be taken with or without food
Reversal Agent	Andexxa	Andexxa

Making an Informed Decision

Choosing an anticoagulant requires consulting a healthcare provider. Factors like bleeding risk, kidney function, and specific conditions are crucial. Eliquis's twice-daily dose might be safer for some due to potentially lower bleeding risk. The best choice is based on a personalized risk-benefit assessment. More information can be found on sites like {Link: Medical News Today https://www.medicalnewstoday.com/articles/drugs-xarelto-vs-eliquis}.

Conclusion

Xarelto and Eliquis are not the same, despite being in the same class and preventing clots. Their differences in dosing, bleeding risk, approved uses, and kidney considerations emphasize the need for an individualized treatment plan. Understanding these distinctions helps patients discuss the safest option with their doctors.

Frequently Asked Questions

The main difference is the dosing schedule. Eliquis is typically taken twice a day, while Xarelto is most often taken once a day for many conditions.

Some studies suggest that Eliquis may carry a lower risk of major bleeding compared to Xarelto, particularly for older adults with atrial fibrillation. However, both medications have bleeding risks, and a doctor's consultation is necessary to determine the best choice for you.

Yes, both Xarelto and Eliquis have a specific reversal agent called Andexxa (andexanet alfa), which can be used to stop life-threatening or uncontrolled bleeding.

For patients with moderate to severe kidney impairment, Eliquis may be a better option because its clearance is less dependent on kidney function compared to Xarelto.

Both medications can be very expensive, as they have been available mainly as brand-name drugs. However, a generic version of Xarelto 2.5 mg is now available, and a generic for Eliquis is expected later due to patent protection.

Yes, it is possible to switch between the two medications, but it must be done under the strict guidance of a healthcare provider. Do not stop taking one medication and start the other without a doctor's instructions.

Unlike warfarin, another anticoagulant, Xarelto and Eliquis do not require any specific dietary restrictions regarding vitamin K intake. However, Xarelto should be taken with food for certain uses, while Eliquis can be taken with or without food.