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Eliquis vs Xarelto
Introduction
For patients at risk of blood clots due to conditions such as atrial fibrillation or following certain types of surgery, anticoagulant medications that inhibit the formation of blood clots can be lifesaving. Eliquis and Xarelto are two such drugs often prescribed for these purposes. They each function by inhibiting a specific part of the coagulation cascade, which is a series of chemical reactions in the body leading to the formation of a clot. Eliquis (apixaban) and Xarelto (rivaroxaban) both inhibit Factor Xa, an enzyme necessary for forming blood clots, but they do so in slightly different ways. Eliquis requires twice-daily dosing whereas Xarelto usually only needs once-daily administration; however, their overall effectiveness and safety profiles are similar.
Eliquis vs Xarelto Side By Side
| Attribute | Eliquis | Xarelto |
|---|---|---|
| Brand Name | Eliquis | Xarelto |
| Contraindications | Should not be taken with antiplatelet agents, NSAIDs, and some types of antidepressants (SSRIs/SNRIs). | Should not be taken with antiplatelet agents, NSAIDs, and some types of antidepressants (SSRIs/SNRIs). |
| Cost | Around $500 for 60 tablets of 5 mg | Around $470 for 30 tablets of 20 mg |
| Generic Name | Apixaban | Rivaroxaban |
| Most Serious Side Effect | Signs of bleeding such as unusual bruising or bleeding that won't stop; blood in your urine, stools (black or tarry), or vomit (that looks like coffee grounds); coughing up blood; cuts that don't stop bleeding. | Unexpected bleeding or bleeding that lasts a long time, unusual bruising, persistent or severe headache, dizziness or fainting spells, difficulty in swallowing, back pain, severe abdominal pain. |
| Severe Drug Interactions | Increased risk of bleeding when taken with antiplatelet agents, NSAIDs, and some antidepressants. | Increased risk of bleeding when taken with antiplatelet agents, NSAIDs, and some antidepressants. |
| Typical Dose | 2.5–5 mg taken twice daily | 15 mg taken orally twice daily with food for the first 21 days, then 20 mg once daily with food |
What is Eliquis?
Apixaban (the generic name for Eliquis) and Rivaroxaban (the generic name for Xarelto) are both part of a new class of anticoagulants known as direct oral anticoagulants (DOACs). These drugs marked a significant advancement over the traditional use of warfarin, an older type of blood thinner. Apixaban was first approved by the FDA in 2012. Eliquis works by selectively inhibiting factor Xa within the coagulation cascade, thereby preventing clot formation. It is prescribed to prevent strokes in patients with atrial fibrillation and to treat and prevent deep vein thrombosis or pulmonary embolism. Compared to Rivaroxaban, Apixaban has fewer dietary restrictions and lower bleeding risks due to its more specific inhibition on Factor Xa alone without affecting other pathways that could lead to increased bleeding tendencies.
What conditions is Eliquis approved to treat?
Eliquis is approved for the treatment of several clot-related disorders:
- Prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation
- Treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE)
- Reduction in the risk of recurrent DVT and PE following initial therapy
How does Eliquis help with these illnesses?
Eliquis (apixaban) and Xarelto (rivaroxaban) are both anticoagulant medications, commonly referred to as blood thinners. They work by inhibiting the formation of blood clots in your body. Both drugs achieve this by blocking the action of a specific protein that plays a key role in the clotting process called factor Xa.
However, they do have some differences. While Eliquis works by directly inhibiting Factor Xa throughout the entire body, preventing its participation in furthering the coagulation cascade which could lead to clot formation, Xarelto is more selective and only targets circulating Factor Xa rather than also affecting already bound Factor Xa within an existing thrombus.
By preventing or reducing clotting, these medications can help prevent conditions such as deep vein thrombosis (DVT), pulmonary embolism (PE), and stroke caused by atrial fibrillation. Deciding between Eliquis and Xarelto often depends on individual patient factors including personal medical history and lifestyle considerations.
What is Xarelto?
Xarelto is a brand name for rivaroxaban, which is an oral anticoagulant. It functions as a direct factor Xa inhibitor, meaning it blocks the action of factor Xa, a clotting factor in the blood that contributes to blood clots formation. Rivaroxaban was first approved by the FDA in 2011. As it does not inhibit vitamin K (unlike warfarin), it doesn't require routine blood monitoring or diet changes due to its interaction with vitamin K found in certain foods. Its lack of interaction with vitamin K means its side-effect profile and management are different than those of warfarin; particularly noteworthy is that it has fewer interactions with food and other drugs. The effects on clotting factors can be beneficial for preventing strokes and systemic embolism in patients with nonvalvular atrial fibrillation, deep vein thrombosis (DVT), pulmonary embolism (PE) and also used as prophylaxis after hip or knee replacement surgeries.
What conditions is Xarelto approved to treat?
Xarelto is an anticoagulant medication that has been approved for the prevention and treatment of several conditions such as:
- Deep vein thrombosis (DVT)
- Pulmonary embolism (PE)
- Reducing risk of stroke in people with atrial fibrillation
- Preventing blood clots in individuals undergoing knee or hip replacement surgery
How does Xarelto help with these illnesses?
Factor Xa is a crucial enzyme in the process of blood clotting, playing pivotal roles in the formation of thrombin, which subsequently transforms fibrinogen into fibrin - the substance that forms clots. As with other types of coagulation factors, high levels or overactivity of Factor Xa can lead to excessive clotting and potentially life-threatening conditions such as deep vein thrombosis or pulmonary embolism. Xarelto works by selectively inhibiting Factor Xa, thereby reducing its activity and lowering the risk for dangerous blood clot formation. Its action on this specific pathway may also contribute to fewer instances of bleeding compared to other anticoagulants like Eliquis. Since it does not significantly affect other coagulation pathways, it is sometimes prescribed when a patient has previously experienced adverse reactions to typical anticoagulants (such as Eliquis), or may even be combined with them under certain circumstances.
How effective are both Eliquis and Xarelto?
Both apixaban (Eliquis) and rivaroxaban (Xarelto) are anticoagulant medications with a track record of efficacy in preventing stroke and systemic embolism in patients with nonvalvular atrial fibrillation. These drugs were approved by the FDA within two years of each other, with Xarelto gaining approval in 2011 and Eliquis following suit in 2012. As they inhibit different steps within the coagulation cascade, their prescription might be dictated by specific patient circumstances.
A direct comparison was carried out between these two drugs in terms of risk for major bleeding events when used to treat venous thromboembolism; both showed similar safety profiles as well as effectiveness[1]. In this study, no significant differences were observed across various metrics designed to measure effectiveness and safety between patients receiving either medication.
A systematic review conducted on apixaban demonstrated its efficacy at providing stroke prevention starting from early stages of treatment while also presenting fewer concerns around bleeding compared to warfarin–another widely prescribed anticoagulant [2]. Furthermore, it's been observed that due to favorable pharmacological properties such as lower drug-drug interactions and predictable pharmacokinetics, Eliquis has become one of the most frequently selected new oral anticoagulants worldwide.
Rivaroxaban has also shown comparable efficacies against placebo or standard therapy for prevention or treatment of deep vein thrombosis (DVT), pulmonary embolism (PE), stroke prevention in atrial fibrillation (AF), after hip or knee replacement surgery among others. Typically considered a first-line treatment option for these indications due to convenience: once-daily dosing without the need for regular blood tests unlike earlier generation anticoagulants like warfarin [3].
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6433055/ [2] https://pubmed.ncbi.nlm.nih.gov/23744564/ [3] https://www.nps.org.au/radar/articles/direct-acting-oral-anticoagulants-daocs-for-prevention-of-stroke-in-non-valvular-atrial-fibrillation
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At what dose is Eliquis typically prescribed?
Oral dosages of Eliquis typically range from 2.5–5 mg taken twice daily, depending on the specific condition and patient characteristics such as age, kidney function, and body weight. For Xarelto, the most common dosage is 20 mg once daily for patients with non-valvular atrial fibrillation. However, in certain conditions like deep vein thrombosis (DVT) or pulmonary embolism (PE), it may be initially given at a higher dose of 15mg twice daily for three weeks before reducing to a maintenance dose of 20mg once daily. In either drug regimen, dosage adjustments may be necessary based on clinical response and side effects. It's essential that these medications are not discontinued without consulting your healthcare provider due to the potential risk of blood clots.
At what dose is Xarelto typically prescribed?
Xarelto treatment is typically initiated at a dosage of 15 mg taken orally twice daily with food for the first 21 days. After this initial period, the dose can be reduced to 20 mg once daily with food. This reduction helps manage long-term maintenance therapy and lower the risk of recurring deep vein thrombosis (DVT) or pulmonary embolism (PE). In cases where there are renal impairments, adjustments may need to be made based on creatinine clearance levels. Always consult your physician before making any changes to dosing schedules or medication regimens.
What are the most common side effects for Eliquis?
The common side effects of Eliquis and Xarelto include:
- Unusual bleeding (nose, mouth, vagina, or rectum), bleeding from wounds or needle injections
- Any bleeding that will not stop
- Heavy menstrual periods
- Hematuria (blood in your urine)
- Hemoptysis (coughing up blood)
- Black or bloody stools, rectal bleeding
- Tarry stools
- Pink or brown urine
- Feeling dizzy or weak
- Headache and feeling like you might pass out easy bruising
If you experience any of these symptoms while taking either drug, seek immediate medical attention.
Are there any potential serious side effects for Eliquis?
Eliquis and Xarelto are both anticoagulant medications used to prevent blood clots. However, they can cause potentially serious side effects in rare cases:
- Signs of bleeding such as unusual bruising or bleeding that won't stop; blood in your urine, stools (black or tarry), or vomit (that looks like coffee grounds); coughing up blood; cuts that don't stop bleeding.
- Allergic reactions: hives, difficulty breathing, swelling of the face or throat
- Symptoms related to a spinal cord blood clot if you've had an epidural: back pain, numbness or muscle weakness in your lower body, loss of bladder control
- Heart-related issues including chest pain which might lead to heart attack
- Liver problems - yellowing eyes/skin (jaundice), dark urine
- Stroke symptoms like sudden dizziness/fainting/unconsciousness, confusion, slurred speech
If you experience any of these symptoms while taking Eliquis or Xarelto it is critical for you to seek medical assistance immediately.
What are the most common side effects for Xarelto?
While taking Xarelto, you may experience some side effects such as:
- Bleeding gums
- Blood in the urine or stools
- Headache or dizziness
- Coughing up blood or vomit that looks like coffee grounds
- Bruising more easily than usual, prolonged bleeding from cuts
- Swelling in your limbs
- Weakness, fatigue, feeling faint
- Nausea, stomach pain and diarrhea Please note that these are serious side effects due to its major role as an anticoagulant. If any of these symptoms occur while using Xarelto, seek medical help immediately.
Are there any potential serious side effects for Xarelto?
While Xarelto is an effective blood thinner, it can also lead to several serious side effects. These may include:
- Signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
- Unexpected bleeding or bleeding that lasts a long time
- Unusual bruising
- Persistent or severe headache
- Dizziness or fainting spells
- Difficulty in swallowing
- Back pain -Severe abdominal pain
Remember to reach out to your healthcare provider immediately if you experience any of these symptoms while taking Xarelto. The safety and efficacy of this medication largely depend on its appropriate use and careful monitoring by a healthcare professional.
Contraindications for Eliquis and Xarelto?
Both Eliquis and Xarelto, as with most other anticoagulant medications, may increase the risk of bleeding. If you notice any unusual bleeding or bruising, changes in urine or stool color to red or black, vomiting blood, prolonged nosebleeds or gum bleeds please seek immediate medical attention.
Neither Eliquis nor Xarelto should be taken if you are taking certain classes of drugs like antiplatelet agents (like clopidogrel), nonsteroidal anti-inflammatory drugs (NSAIDs) and some types of antidepressants (SSRIs/SNRIs). Always inform your healthcare provider about all the medications that you're currently taking; these drugs can interact with Eliquis and Xarelto increasing the risk for bleeding.
If undergoing a surgical procedure it is important to tell your doctor that you are on either medication as they might require discontinuation prior to surgery due to increased risk for bleeding complications.
How much do Eliquis and Xarelto cost?
For the brand name versions of these drugs:
- The price for 60 tablets of Eliquis (5 mg) averages around $500, which works out to approximately $16.70 per day, given that it's typically taken twice a day.
- The price for 30 tablets of Xarelto (20 mg), is roughly similar at about $470, but since it's usually taken once daily, this works out to be about $15.70/day.
Thus, if you are prescribed the common dosage for these medications, then brand-name Xarelto is less expensive on a per-day treatment basis than Eliquis. However, cost should not be a primary consideration in determining which anticoagulant medication is right for you.
As of now there are no generic versions available either for apixaban (Eliquis) or rivaroxaban (Xarelto). Therefore costs remain relatively high compared to some other classes of medication where generics are available.
Popularity of Eliquis and Xarelto
Apixaban, commonly known by the brand name Eliquis, was estimated to have been prescribed to about 9.6 million people in the US in 2020. Apixaban accounted for just over 30% of anticoagulant prescriptions in the US and has seen a steady rise since its approval by FDA in 2012 due to its effectiveness and reduced risk of major bleeding.
Rivaroxaban, also recognized as Xarelto, was prescribed to approximately 8 million people in the USA during that same year. In terms of popular anticoagulants, rivaroxaban accounts for nearly a quarter (24%) of all blood thinner prescriptions. The drug's prevalence peaked around mid-2015 but has remained fairly stable since then as physicians continue to manage patients' risks between clot prevention and excessive bleeding.
Conclusion
Both Eliquis (apixaban) and Xarelto (rivaroxaban) are anticoagulants used to prevent blood clots. They have been thoroughly researched in clinical studies, indicating that they perform better than traditional treatments like warfarin in preventing strokes and systemic embolism. These two drugs work by inhibiting factor Xa, an enzyme involved in the formation of blood clots.
While both medications serve similar purposes, there are some differences between them. Eliquis is usually taken twice a day while Xarelto is typically prescribed once daily. Due to these variations, they may be preferred under different circumstances depending on individual patient needs and lifestyle considerations.
On the financial side, both medicines can be expensive for patients without insurance since they're still under patent protection with no generic versions available yet.
Just like Prozac and Wellbutrin mentioned above, starting either of these medications might require careful monitoring as it takes time for the body to adjust and achieve effective anticoagulation levels.
The side effect profiles of Eliquis and Xarelto are comparable; however, Eliquis has been associated with slightly fewer major bleeding events compared to Xarelto in certain populations. As always when taking such potent medications, patients should promptly seek medical attention if they notice unusual bruising or bleeding.
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Refrences
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- Agrawal, R., Jain, P., & N. Dikshit, S. (2012, May 1). Apixaban: A New Player in the Anticoagulant Class. Current Drug Targets. Bentham Science Publishers Ltd.http://doi.org/10.2174/138945012800564059
- Laux, V., Perzborn, E., Kubitza, D., & Misselwitz, F. (2007, July). Preclinical and Clinical Characteristics of Rivaroxaban: A Novel, Oral, Direct Factor Xa Inhibitor. Seminars in Thrombosis and Hemostasis. Georg Thieme Verlag KG.http://doi.org/10.1055/s-2007-982083
- Sarich, T. C., Peters, G., Berkowitz, S. D., Misselwitz, F., Nessel, C. C., Burton, P., … DiBattiste, P. M. (2013, May 23). Rivaroxaban: a novel oral anticoagulant for the prevention and treatment of several thrombosis‐mediated conditions. Annals of the New York Academy of Sciences. Wiley.http://doi.org/10.1111/nyas.12136
- Cheng, J. W., & Barillari, G. (2014, January 3). Non-vitamin K antagonist oral anticoagulants in cardiovascular disease management: evidence and unanswered questions. Journal of Clinical Pharmacy and Therapeutics. Hindawi Limited.http://doi.org/10.1111/jcpt.12122
- Melo, F., & Mourão, P. (2008). An algal sulfated galactan has an unusual dual effect on venous thrombosis due to activation of factor XII and inhibition of the coagulation proteases. Thrombosis and Haemostasis. Georg Thieme Verlag KG.http://doi.org/10.1160/th07-10-0649
- Keating, G. M. (2013, May 16). Apixaban: A Review of its Use for Reducing the Risk of Stroke and Systemic Embolism in Patients with Nonvalvular Atrial Fibrillation. Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40265-013-0063-x