Understanding Eliquis and Xarelto
Both Eliquis (apixaban) and Xarelto (rivaroxaban) are direct oral anticoagulants (DOACs) that inhibit Factor Xa, an enzyme essential for blood clotting. This action reduces the risk of stroke, deep vein thrombosis (DVT), and pulmonary embolism (PE). While their mechanism is similar, key differences exist in dosing, safety, and indications.
Efficacy: How Effective Are They?
Studies comparing Eliquis and Xarelto for stroke prevention in patients with atrial fibrillation (AFib) have yielded varied results. A 2021 study found Eliquis preferable due to lower rates of stroke, systemic embolism, and major bleeding. For treating DVT and PE, both medications are generally considered comparably effective, though some research suggests Eliquis may have a safety advantage due to lower bleeding risk. Individual patient factors influence efficacy.
Bleeding Risk and Safety Profile
Bleeding is a primary concern with anticoagulants. Many studies indicate that Eliquis has a more favorable safety profile with a lower risk of major bleeding compared to Xarelto, particularly in patients with AFib and in older adults (65+). Common side effects for both include easy bruising and nosebleeds, but serious bleeding is possible. Patients should discuss these risks with their doctor.
Dosing and Convenience
Dosing schedules differ significantly:
- Xarelto (rivaroxaban) is usually taken once daily, which can be more convenient for some patients.
- Eliquis (apixaban) is typically taken twice daily. This schedule helps maintain consistent drug levels and may contribute to its safety profile.
Other Considerations and Patient-Specific Factors
Other factors influencing the choice include:
- Approved Uses: Xarelto has broader FDA approvals, including some pediatric uses and for reducing cardiovascular risk in patients with CAD or PAD when used with aspirin.
- Kidney Function: Eliquis is often preferred for patients with moderate to severe kidney issues as it is less reliant on the kidneys for elimination.
- Cost: Both branded medications are expensive, with costs varying by insurance. While a generic Eliquis is approved, it's not widely available. A partial generic Xarelto (2.5mg) exists, but a full generic is not expected soon.
Eliquis vs. Xarelto: Comparison Table
| Feature | Eliquis (apixaban) | Xarelto (rivaroxaban) |
|---|---|---|
| Dosing | Twice daily (most cases) | Once daily (most cases) |
| Bleeding Risk | Generally lower risk of major bleeding | Higher risk of major bleeding in some studies |
| Efficacy (AFib) | Possibly slightly more effective in preventing stroke | Highly effective, but possibly less so than Eliquis in some studies |
| Efficacy (DVT/PE) | Effective, comparable to Xarelto, possibly safer | Effective, comparable to Eliquis |
| Approved Indications | Standard adult indications | Broader, including some pediatric and specific cardiovascular uses |
| Kidney Function | Often preferred for patients with impaired kidney function | May require dose adjustment for impaired kidney function |
| Age Considerations | Lower bleeding risk in older adults | Bleeding risk increases with age |
| Convenience | Less convenient twice-daily dosing | More convenient once-daily dosing |
Conclusion
Determining if is Eliquis better than Xarelto requires considering individual patient factors. While Eliquis may offer a lower bleeding risk, especially in older adults with AFib, Xarelto provides once-daily convenience and broader approved uses. The best choice is made in consultation with a healthcare provider who can assess the patient's medical history, risks, and preferences.
Who Should Consult a Doctor?
Patients should consult a doctor before switching medications, for questions about side effects, or to determine the best medication for their specific condition. For additional information, a Vanderbilt University study provides insight into apixaban's preference over rivaroxaban for stroke prevention.
