Eliquis vs. Xarelto: The Short Answer
Apixaban (Eliquis) and rivaroxaban (Xarelto) are the two most widely used modern blood thinners. Both prevent strokes in people with atrial fibrillation, and both treat and prevent blood clots in the legs and lungs. Both work faster, interact with fewer foods, and need far less blood-test monitoring than the older drug warfarin.
The main differences are practical. Apixaban is taken twice a day, with or without food. Rivaroxaban is taken once a day for most uses, and its larger doses need to be taken with a meal. Large observational studies have generally found less major and stomach bleeding with apixaban, though the two have not been compared head to head in a large randomized trial for atrial fibrillation. For many people, either is an excellent choice.
How These Blood Thinners Work
Both drugs block factor Xa, a key protein in the chain of reactions that forms a blood clot. With less factor Xa available, clots form more slowly. That protects against the clots that cause strokes in atrial fibrillation and against deep vein thrombosis and pulmonary embolism. Because they act directly on one clotting factor, doctors call them direct oral anticoagulants, or DOACs.
What they are approved for
- Both: lowering stroke risk in atrial fibrillation not caused by a heart valve problem, treating DVT and pulmonary embolism, lowering the chance of a repeat clot, and preventing clots after hip or knee replacement
- Rivaroxaban also: a low-dose version, combined with aspirin, to lower the risk of heart attack and stroke in some people with coronary or peripheral artery disease
Dosing and Daily Life
Twice a day vs. once a day
Apixaban's twice-daily schedule keeps blood levels steadier through the day, and a single missed dose leaves a shorter gap in protection. Rivaroxaban's once-daily schedule is simpler for people who struggle with multiple doses, but a missed dose means a longer stretch with less protection. The best schedule is the one you will actually follow every day.
Food
Apixaban can be taken with or without food. The atrial fibrillation and clot-treatment doses of rivaroxaban need to be taken with a meal, usually the evening meal, so the body absorbs enough of the drug. If your appetite is unpredictable, that matters.
Bleeding Risk
Every blood thinner raises bleeding risk; that is the trade-off for preventing clots. Observational data from large numbers of patients have generally favored apixaban for lower rates of major bleeding and gastrointestinal bleeding. Your personal bleeding risk depends on more than the drug choice:
- Age and kidney function
- Past stomach ulcers or bleeding
- Other medicines, especially aspirin, ibuprofen, naproxen, and some antidepressants
- Alcohol use and fall risk
Both drugs have a specific reversal agent for life-threatening bleeding, which hospitals can use in an emergency. The MedlinePlus guides to apixaban and rivaroxaban list the warning signs of bleeding.
Kidney Function and Interactions
Both medicines are partly cleared by the kidneys, so doctors check kidney function before starting and periodically after. Apixaban depends somewhat less on the kidneys, which can make it a smoother fit for people with reduced kidney function. Doses of either may need adjustment based on age, weight, and kidney numbers.
Both interact with certain antifungals, HIV medicines, seizure medicines such as carbamazepine, the antibiotic rifampin, and St. John's wort. Bring every prescription and supplement to your visits. Our article on polypharmacy explains why a medication review matters for anyone on a blood thinner.
Who Should Not Take Either One
- Mechanical heart valves: warfarin remains the standard; DOACs are not safe here.
- Moderate to severe mitral stenosis: warfarin is generally preferred.
- Antiphospholipid syndrome, especially the high-risk form: DOACs have performed worse than warfarin, so our team reviews this carefully. See our page on antiphospholipid syndrome.
- Active serious bleeding.
Never stop on your own
Both drugs carry a boxed warning that stopping early raises the risk of stroke and clots. If you need a procedure, a dental extraction, or a break for any reason, let us plan the pause with you and your surgeon.
Cost and Coverage
Coverage and copays differ by plan, and the cheaper choice for you depends on your insurance. Both were among the first drugs with Medicare-negotiated prices, which took effect in 2026, so it is worth rechecking your costs if you have Medicare Part D. The MedlinePlus overview of blood thinners covers general safety habits for any anticoagulant.
Living on a Blood Thinner in Florida
Falls are the big worry for older adults on any anticoagulant. A hard hit to the head while on apixaban or rivaroxaban deserves prompt evaluation even if you feel fine, because bleeding inside the skull can develop slowly. Our fall prevention guide covers practical steps. Snowbirds who drive or fly long distances should also read our article on travel and blood clots, and carry enough medicine for the whole trip plus a buffer for hurricane-season delays.
When to See Your Doctor
- Black or bloody stools, vomiting blood, or blood in the urine
- Nosebleeds or gum bleeding that will not stop
- Unusual bruising, or a large, painful bruise without injury
- Any significant head injury, even without symptoms (seek care promptly)
- Sudden weakness, numbness, trouble speaking, or vision loss (call 911)
- New swelling, pain, or warmth in one leg, or sudden shortness of breath
Wondering whether your blood thinner is the best match for your heart, kidneys, and routine? Schedule a visit and we will review it with you.
