Side-by-Side
Quick Comparison
Key attributes at a glance. "Advantage" notes reflect general clinical and observational data; individual results vary.
| Attribute | Eliquis (apixaban) | Xarelto (rivaroxaban) |
|---|---|---|
| Drug class | Direct oral anticoagulant (DOAC) | Direct oral anticoagulant (DOAC) |
| Mechanism | Direct factor Xa inhibitor | Direct factor Xa inhibitor |
| Manufacturer | Bristol-Myers Squibb / Pfizer | Janssen / Bayer |
| Available strengths | 2.5 mg · 5 mg | 2.5 mg · 10 mg · 15 mg · 20 mg |
| Dosing frequency | Twice daily (BID) Neutral |
Once daily (QD) for AFib/VTE ▲ Adherence advantage |
| AFib stroke prevention | ✓ Approved (ARISTOTLE trial) | ✓ Approved (ROCKET-AF trial) |
| DVT/PE treatment | ✓ Approved | ✓ Approved |
| VTE prophylaxis (post-surgical) | ✓ Approved | ✓ Approved |
| Cardiovascular disease (CAD/PAD) | Not approved | ✓ Approved (low-dose + aspirin; COMPASS trial) ▲ Broader indication |
| GI bleeding risk | Lower vs rivaroxaban in comparative studies ▲ Eliquis advantage |
Higher vs apixaban; clinically meaningful difference |
| Food requirement | None — take with or without food ▲ More flexible |
Take with evening meal for AFib/VTE doses (food increases absorption) |
| Reversal agent | Andexxa (andexanet alfa) | Andexxa (andexanet alfa) |
| INR monitoring required | No | No |
| Key drug interactions | CYP3A4 / P-gp inhibitors & inducers (e.g., azole antifungals, rifampin); avoid dual anticoagulation | CYP3A4 / P-gp inhibitors & inducers; avoid dual anticoagulation; NSAIDs increase bleeding risk (both) |
| Generic availability | Yes — US market (2026) ▲ Lower cost option |
Varies by country; limited in US as of 2026 |
Where They Diverge
Key Differences
Once-daily dosing may improve adherence, though missing a single Xarelto dose has a larger proportional impact on coverage.
Multiple large observational studies — including analyses of real-world claims data — show Eliquis is associated with lower rates of gastrointestinal bleeding compared to Xarelto. For patients with prior GI bleeding or high GI risk, this distinction is often a deciding factor.
Xarelto (low-dose 2.5 mg twice daily plus aspirin) is approved for patients with chronic coronary artery disease or peripheral artery disease to reduce cardiovascular events, based on the COMPASS trial. Eliquis lacks this indication.
Generic apixaban entered the US market in 2026, offering significant savings over brand-name Eliquis. Generic rivaroxaban availability in the US remains limited as of the same date. Internationally, availability varies — patients should check local formularies.
ARISTOTLE (apixaban): Fewer strokes AND fewer major bleeding events vs warfarin — an unusual dual win in anticoagulation trials.
ROCKET-AF (rivaroxaban): Non-inferior to warfarin for stroke prevention; reduced intracranial bleeding.
COMPASS (rivaroxaban): Low-dose plus aspirin reduced major adverse CV events in stable CAD/PAD.
Common Ground
What They Share
Both drugs represent a significant advance over warfarin for most patients.
Pill Identification
Common Tablet Imprints
Imprints appear embossed on the tablets and are used to identify pills. Always verify with a pharmacist if uncertain.
Frequently Asked
Common Questions
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Both Eliquis and Xarelto are considered safer than warfarin for most patients. Comparative data is largely observational, but multiple large studies and meta-analyses generally show Eliquis (apixaban) carries a lower risk of major bleeding — particularly gastrointestinal bleeding — than Xarelto (rivaroxaban). Intracranial bleeding risk is comparably low for both. The "safest" choice for any individual depends on their specific indication, kidney function, medication list, lifestyle, and adherence habits. This decision belongs to a prescriber, not a comparison chart.
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Eliquis (apixaban) consistently shows a lower gastrointestinal bleeding risk compared to Xarelto (rivaroxaban) in real-world comparative studies. The ARISTOTLE trial demonstrated that Eliquis caused fewer bleeding events than warfarin; direct comparisons between the two DOACs in large observational datasets have favored apixaban for GI safety. For intracranial bleeding, both drugs perform similarly and better than warfarin. For patients with a prior GI bleed or elevated GI risk, this difference is often clinically meaningful.
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Xarelto (rivaroxaban) is taken once daily for its AFib stroke-prevention and VTE indications. Eliquis (apixaban) is taken twice daily. Once-daily dosing is often preferred by patients for simplicity and may improve adherence. However, a missed dose of Xarelto represents a larger gap in anticoagulant coverage than a missed dose of twice-daily Eliquis.
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Yes. Andexxa (andexanet alfa) is FDA-approved to reverse both Eliquis and Xarelto in patients with life-threatening or uncontrolled bleeding. However, Andexxa is expensive and not universally stocked at every hospital or emergency department. Clinicians at centers without Andexxa typically use 4-factor prothrombin complex concentrates (4F-PCC) as an alternative reversal strategy. If you take either drug, it is worth knowing whether your local emergency center carries Andexxa.
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As of 2026, generic apixaban (Eliquis) has become available in the United States following patent expiry, significantly lowering its out-of-pocket cost compared to the brand. Generic rivaroxaban availability in the US remains limited. Brand-name Xarelto and brand-name Eliquis were similarly priced prior to generics. Internationally, formulary coverage and generic availability differ by country. Patients should compare prices at their pharmacy, check their insurer's formulary tier, and ask about manufacturer patient-assistance programs.
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