Xarelto vs Eliquis 2025: Which Blood Thinner Is Better?
Updated November 2025 | Head-to-head comparison: safety, dosing, cost, missed dose risks
Short answer: Eliquis (apixaban) is safer with lower bleeding risk and slightly better stroke prevention. Xarelto (rivaroxaban) wins on convenience with once-daily dosing for most uses. Your doctor chooses based on kidney function, bleeding history, and lifestyle.[7]
Side-by-Side Comparison Table
| Feature | Xarelto (Rivaroxaban) | Eliquis (Apixaban) | Winner |
|---|---|---|---|
| Stroke Prevention (AFib) | 20% better vs warfarin[7] | 21% better vs warfarin[7] | Eliquis (tie) |
| Major Bleeding Risk | 3.6% per year | 2.1% per year[7] | Eliquis |
| Dosing Frequency | Once daily (most uses) | Twice daily | Xarelto |
| Food Requirement | With evening meal (15/20 mg) | With or without food | Eliquis |
| Kidney Adjustment | CrCl 15–50: 15 mg | 2 of 3: age ≥80, weight ≤60 kg, Cr ≥1.5 | Eliquis (more flexible) |
| Reversal Agent | Andexxa (approved) | Andexxa (approved) | Tie |
| Cost (30-day, no insurance) | $580[16] | $594[16] | Xarelto (slightly) |
| Medicare Cap 2026 | $231 for both[17] | Tie | |
| Missed Dose Risk | Stroke risk up 10–20% in 24h | Stroke risk up 10–20% in 12h | Eliquis (longer half-life) |
Key Differences Explained
1. Safety: Eliquis Has Lower Bleeding Risk
The ARISTOTLE (Eliquis) and ROCKET-AF (Xarelto) trials can't be directly compared, but a 2021 meta-analysis of 200,000+ patients found:
- Eliquis: 31% lower major bleeding than Xarelto[7]
- Eliquis: Lower intracranial hemorrhage (brain bleeds)
2. Dosing: Xarelto Is More Convenient
- Xarelto: 20 mg once daily with dinner for AFib/DVT maintenance
- Eliquis: 5 mg twice daily (every 12 hours)
Adherence alert: Twice-daily meds have 15% higher miss rates. Use a reminder![28]
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3. Cost: Nearly Identical in 2025
- Without insurance: Xarelto ~$580, Eliquis ~$594
- Medicare 2026: Both capped at $231 under IRA
- Generics: Both available — prices dropping to $300–$400
4. Missed Dose Danger: Both High-Risk
Both are DOACs — missing one dose spikes clot risk 10–20% within hours.[8] Eliquis has a longer half-life (12h vs 5–9h), giving a slight buffer if you're late.
Which Should You Take?
| Choose Xarelto if: | Choose Eliquis if: |
|---|---|
| You hate twice-daily pills | You have high bleeding risk (GI history, age >75) |
| You eat dinner consistently | You want max stroke prevention |
| Kidney function CrCl 15–50 | Weight ≤60 kg or age ≥80 |
FAQs
- Can I switch from Xarelto to Eliquis?
- Yes — stop Xarelto, start Eliquis next scheduled dose. No overlap needed.[1]
- Is one better for DVT treatment?
- Both equal. Xarelto: 15 mg twice → 20 mg once. Eliquis: 10 mg twice → 5 mg twice.