Deciding between Xarelto and Eliquis? COMPARE.EDU.VN offers a detailed comparison to help you make an informed choice. Both medications are effective anticoagulants, but understanding their differences in indications, efficacy, and side effects is crucial. This guide provides an in-depth analysis, considering factors like bleeding risks, drug interactions, and costs. Optimize your health decisions with COMPARE.EDU.VN’s expert insights, focusing on stroke prevention, embolism treatment, and atrial fibrillation management.
1. What Are the Key Differences Between Xarelto and Eliquis?
Xarelto (rivaroxaban) and Eliquis (apixaban) are both oral anticoagulants known as factor Xa inhibitors, prescribed to prevent and treat blood clots. The primary distinctions lie in their approved uses, dosing frequencies, and specific risk profiles.
Xarelto offers a broader range of FDA-approved indications, including use in pediatric patients and specific conditions like chronic coronary artery disease (CAD) and peripheral artery disease (PAD) when combined with aspirin. Eliquis, on the other hand, is primarily used in adults to reduce the risk of stroke and systemic embolism in nonvalvular atrial fibrillation, and for the treatment and prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE).
Dosing frequency also differs, with Xarelto typically administered once daily, while Eliquis is taken twice daily. Studies suggest that Eliquis may present a slightly lower risk of bleeding compared to Xarelto, although both medications are generally considered safe and effective.
| Feature | Xarelto (Rivaroxaban) | Eliquis (Apixaban) |
|---|---|---|
| Drug Class | Factor Xa Inhibitor | Factor Xa Inhibitor |
| Administration | Oral Tablet | Oral Tablet |
| Dosage Frequency | Once Daily (typically) | Twice Daily |
| Generic Available? | No | No |
| Main Uses | Prevention of stroke in atrial fibrillation, DVT/PE treatment & prevention, CAD/PAD risk reduction (with aspirin) | Prevention of stroke in atrial fibrillation, DVT/PE treatment & prevention |
| Bleeding Risk | May be slightly higher | May be slightly lower |
| Pediatric Use | Approved for some uses | Not approved |
2. What Conditions Do Xarelto and Eliquis Treat?
Both Xarelto and Eliquis share common indications, but Xarelto boasts a broader spectrum of FDA-approved uses. Both drugs are prescribed to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. They are also used for the prophylaxis of deep vein thrombosis (DVT), which can lead to pulmonary embolism (PE), in patients undergoing hip or knee replacement surgery, as well as for the treatment of DVT and PE. Furthermore, both are effective in reducing the risk of recurrent DVT and PE following initial therapy.
Xarelto uniquely extends its utility to include prophylaxis of venous thromboembolism (VTE) and VTE-related death during hospitalization and post-hospital discharge in adult patients admitted for an acute medical illness who are at risk for thromboembolic complications due to restricted mobility or other risk factors, provided they are not at high risk of bleeding. In combination with aspirin, Xarelto is also indicated to reduce the risk of major cardiovascular events, such as cardiovascular death, myocardial infarction (MI), and stroke, in patients with chronic coronary artery disease (CAD) or peripheral artery disease (PAD). This combination therapy also reduces the risk of major clotting events in patients with peripheral artery disease, including those who have undergone lower extremity revascularization.
Notably, Xarelto is approved for use in pediatric patients, treating VTE and reducing the risk of recurrent VTE in children from birth to less than 18 years after at least 5 days of initial parenteral (non-oral) anticoagulant treatment. It is also used to prevent VTE in children 2 years and older with congenital heart disease who have undergone the Fontan procedure.
| Condition | Xarelto | Eliquis |
|---|---|---|
| Nonvalvular Atrial Fibrillation (Stroke Risk Reduction) | Yes | Yes |
| DVT/PE Treatment | Yes | Yes |
| DVT/PE Prevention (Post-Surgery) | Yes | Yes |
| Recurrent DVT/PE Risk Reduction | Yes | Yes |
| VTE Prophylaxis in Acutely Ill Hospitalized Patients | Yes | No |
| CAD/PAD Risk Reduction (with Aspirin) | Yes | No |
| Pediatric VTE Treatment and Prevention | Yes | No |
3. Is Xarelto or Eliquis More Effective in Preventing Blood Clots?
Multiple studies have compared the effectiveness of Xarelto and Eliquis in preventing blood clots, particularly in the context of venous thromboembolism (VTE) and atrial fibrillation. A meta-analysis of these studies suggests that both drugs demonstrate similar efficacy in treating acute VTE. However, some data indicates that Eliquis may offer a slightly better safety profile due to a potentially lower risk of bleeding.
Research published in the Annals of Internal Medicine found that patients taking Xarelto experienced a higher incidence of both bleeding and ischemic events (clots and strokes). Similarly, a study in JAMA involving older adults revealed that those in the rivaroxaban group (Xarelto) had more clotting and bleeding events compared to the apixaban group (Eliquis).
A separate review comparing Eliquis, Xarelto, Pradaxa, and Coumadin concluded that Eliquis exhibited the most favorable combination of efficacy, safety, and patient compliance. A 2022 trial from the University of Pennsylvania further supported these findings, indicating that patients with atrial fibrillation and associated valvular heart disease who took Eliquis had nearly half the risk of blood clots compared to those taking Xarelto.
4. What Are the Potential Side Effects of Xarelto and Eliquis?
Both Xarelto and Eliquis carry a risk of side effects, with bleeding being the most common concern. This can manifest as nosebleeds, bruising, blood in the urine, or bleeding gums. While most bleeding events are minor, there is a potential for serious or even life-threatening bleeding in rare cases.
Specific side effects associated with Eliquis include nausea and anemia, while Xarelto may cause abdominal or back pain, fatigue, dizziness, itching, anxiety, depression, and insomnia. Allergic reactions, although rare, can occur with either medication, necessitating immediate medical attention if symptoms such as hives, difficulty breathing, or swelling of the face, lips, tongue, or throat develop.
| Side Effect | Xarelto | Eliquis |
|---|---|---|
| Bleeding | Yes | Yes |
| Nausea | No | Yes |
| Anemia | No | Yes |
| Abdominal Pain | Yes | No |
| Back Pain | Yes | No |
| Fatigue | Yes | No |
| Dizziness | Yes | No |
| Itching | Yes | No |
| Anxiety | Yes | No |
| Depression | Yes | No |
| Insomnia | Yes | No |
| Allergic Reaction | Rare | Rare |
5. What Drug Interactions Should I Be Aware Of?
Before starting Xarelto or Eliquis, it’s essential to inform your healthcare provider about all medications you’re taking, including prescription drugs, over-the-counter medications, vitamins, and supplements. Both drugs can interact with substances metabolized by the same enzymes, potentially increasing the risk of bleeding. Enzyme inhibitors like ketoconazole, erythromycin, and ritonavir can elevate the levels of Xarelto or Eliquis in the body, while enzyme inducers like rifampin, carbamazepine, phenytoin, and St. John’s wort can decrease their effectiveness.
Using Xarelto or Eliquis with other anticoagulants, antiplatelet drugs, NSAIDs, or certain antidepressants can also heighten the risk of bleeding. However, in some cases, Xarelto may be prescribed with a low dose of aspirin for specific indications. Your healthcare provider will provide guidance on whether aspirin is appropriate for your treatment.
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6. What Are the Key Warnings and Precautions for Xarelto and Eliquis?
Xarelto and Eliquis both carry a boxed warning, the FDA’s strongest safety alert, addressing the increased risk of clotting events upon premature discontinuation and the potential for epidural or spinal hematoma in patients undergoing neuraxial anesthesia or spinal puncture.
Discontinuing either medication prematurely can elevate the risk of thrombotic events. Epidural or spinal hematomas may occur in patients receiving neuraxial anesthesia or spinal puncture, potentially leading to long-term or permanent paralysis. This risk is heightened in patients with epidural catheters, those taking other medications that affect blood flow, individuals with a history of traumatic or repeated punctures, and those with spinal deformities or surgeries.
Other warnings include the risk of bleeding, which can be serious or fatal, and the recommendation against using these medications in patients with prosthetic heart valves or triple-positive antiphospholipid syndrome (APS). Caution is advised in patients with chronic liver or kidney disease.
7. Can I Take Xarelto or Eliquis During Pregnancy?
Data on the use of Xarelto and Eliquis during pregnancy is limited. Treatment with either medication may increase the risk of bleeding during pregnancy and delivery, as well as bleeding in the fetus or newborn. The use of Xarelto or Eliquis during labor or delivery in individuals receiving an epidural may lead to epidural or spinal hematoma. A shorter-acting anticoagulant may be considered if necessary.
Consulting with an OB-GYN is crucial for guidance on the use of these medications during pregnancy. Generally, they are only used if the benefits outweigh the risks, such as in certain high-risk pregnancies, and with careful monitoring. If you are already taking Xarelto or Eliquis and discover that you are pregnant, seek advice from your OB-GYN.
8. What Is the Cost and Insurance Coverage for Xarelto and Eliquis?
Xarelto and Eliquis are generally covered by insurance and Medicare prescription plans, but copays can vary significantly. Without insurance, a one-month supply (30 tablets of 20 mg) of Xarelto costs approximately $700, while a one-month supply (60 tablets of 5 mg) of Eliquis costs around $780.
However, using a SingleCare card can reduce the cost of Xarelto to just over $400 and Eliquis to less than $475. The actual cost will depend on your insurance plan, pharmacy, and location.
| Medication | Typically Covered by Insurance? | Typically Covered by Medicare? | Cost Without Insurance | Lowest SingleCare Price |
|---|---|---|---|---|
| Xarelto (30, 20 mg tablets) | Yes | Yes | $700 | $400 |
| Eliquis (60, 5 mg tablets) | Yes | Yes | $780 | $475 |
9. Frequently Asked Questions (FAQ) About Eliquis vs. Xarelto
Are Eliquis and Xarelto the Same?
No, Eliquis and Xarelto are not exactly the same, although they are both direct factor Xa inhibitors. Xarelto has more indications, including some uses for children, while Eliquis is not FDA-approved for use in this age group. Xarelto is usually taken once a day, and Eliquis is taken twice daily.
What Is the Most Significant Difference Between Xarelto and Eliquis Side Effects?
A clinical trial found that the risk of bleeding with Xarelto increases with age, a concern for older adults. Eliquis can also cause bleeding, but studies show this is not age-related.
Is Eliquis or Xarelto Better?
Studies 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.
Can I Use Eliquis or Xarelto While Pregnant?
Generally, Eliquis and Xarelto are not used in pregnancy. However, some exceptions may occur in certain patients at high risk for clots. Consult your healthcare provider.
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 bleeds. Ask your healthcare provider if it is safe to drink alcohol.
Is Xarelto Cheaper Than Eliquis?
For a one-month supply, the prices of Xarelto and Eliquis are very similar. The price of Xarelto with a SingleCare coupon is often slightly lower than the price of Eliquis with a SingleCare coupon.
Can You Switch Between Eliquis and Xarelto?
Yes, in some cases, a healthcare provider may decide to switch a patient from Eliquis to Xarelto, or vice versa, based on individual needs and circumstances. This should only be done under medical supervision, with careful dosing instructions provided by the healthcare provider.
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Make the Right Choice with COMPARE.EDU.VN
Choosing the right medication is a critical decision that should be made in consultation with your healthcare provider. However, understanding the key differences between options like Xarelto and Eliquis can empower you to have a more informed discussion.
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Remember, the information provided in this article is for informational purposes only and should not be considered medical advice. Always consult with your healthcare provider before making any decisions about your health or treatment.
