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Xarelto vs. Eliquis: What’s the Best Blood Thinner For You?
Did you know that 2 million Americans take blood thinners every single day? So if you find yourself dealing with atrial fibrillation and heart medication regularly, you aren’t alone.
Tired of making the right decision for your AFib medication?
To be quite honest with you, choosing the right blood thinner medication can feel overwhelming, but we’re here to help. Here are some key differences between Xarelto vs Eliquis!
What Is Atrial Fibrillation, Anyway?
Before we dive in, let’s take a moment to talk about atrial fibrillation first.
Atrial fibrillation (AFib) is an abnormality of the heart rhythm triggered by a heart electrical system problem. The energy of the heart usually flows from the upper chambers (atria) to the lower chambers (ventricles).
In turn, this triggers normal contraction. Then, the electrical flow in atrial fibrillation is erratic, causing the heartbeat to become irregular and quick.
But why is this so important, exactly?
Listen up: atrial fibrillation induces an abnormal heart rhythm. You will often feel a “fluttering” when you check your pulse. You will often feel your heart pounding when atrial fibrillation is fresh at onset or poorly controlled by drugs.
If not treated and quickly controlled, this rapid, irregular heart rate can be dangerous. With AFib, the heart rate is so rapid and erratic that the body does not properly pump blood.
Here’s how it works.
Basically, electricity flows from the top of the heart to the bottom of the heart as the heart beats at a regular rate. This causes the heart muscle to contract, pushing the blood through the body.
Next, the energy flows chaotically in AFib and the heart’s bottom chambers contract irregularly. This so-called fluttering or fibrillation is among the hallmark AFib symptoms.
What’s the Difference Between Xarelto & Eliquis?
If you’re curious about how to tell Xarelto apart from Eliquis, then you’ve come to the right place.
For starters, two brand-name drugs used to treat different clotting disorders are Eliquis and Xarelto. In a nutshell, both drugs are oral anticoagulants in a category of medicines called factor Xa inhibitors.
Here’s how they work.
They function by blocking factor Xa, a critical ingredient in clot formation that produces thrombin. The drugs decrease clot production by blocking factor Xa. But that’s not all.
To begin with, NOAC (novel oral anticoagulants) is a category of newer blood thinners. This is what both Eliquis (apixaban) and Xarelto (rivaroxaban) are categorized under. That said, they’re often referred to as direct oral anticoagulants (DOAC).
Unlike Coumadin (warfarin), patients taking Eliquis or Xarelto do not need daily blood tests to control their blood levels. Yes, you read that right.
Now here comes the hard part: Eliquis and Xarelto are also referred to as inhibitors of factor Xa, although they have certain differences. But how can you possibly tell them apart?
Both Eliquis and Xarelto are approved for prescription use by the FDA and are available only under the brand name. Although there is no generic available for either medication yet, a generic Eliquis should, however, be available soon.
In a nutshell, Bristol-Myers Squibb develops Eliquis, and Janssen Pharmaceuticals produces Xarelto. However, adults use both medications, and the dose varies by indication.
In terms of standard dosage, Eliquis should be taken twice a day, and anywhere between 2.5 milligrams and 5 milligrams is recommended. On the other hand, Xarelto should only be taken once a day, with a dosage of between 10 milligrams and 20 milligrams recommended daily.
What Does Xarelto & Eliquis Treat?
Okay, so what conditions do Xarelto and Eliquis treat, anyway?
We are glad that you asked.
For the uninitiated, there are some similar indications for Eliquis and Xarelto:
- Decreasing the risk of stroke and embolism in AFib patients
- Preventing deep vein thrombosis (DVT) in patients with hip or knee replacement, Treating DVT
- Treating PE
- Reducing the risk of persistent DVT or PE after initial care
Furthermore, Xarelto has several additional treatments. Venous thromboembolism (VTE) and death associated with VTE may be avoided by Xarelto. In adult patients who are at risk for complications, Xarelto is given during hospitalization and after discharge.
Caution: patients who have a high risk of bleeding should not be given Xarelto.
Xarelto is also used with aspirin in patients with chronic coronary artery disease (CAD) or peripheral artery disease (PAD). This can lower the risk of serious cardiovascular problems such as death, heart attack, and stroke.
Which Medication is More Effective?
At this point, you might be wondering if Xarelto or Eliquis is the most effective blood thinner medication.
First off, a study and meta-analysis of acute venous thromboembolism (VTE) for Eliquis and Xarelto concluded that both drugs were equally successful but treatment could be safer with Eliquis. More bleeding, both major and minor, occurred in patients treated with Xarelto.
Eliquis and Xarelto, as well as Pradaxa (another newer anticoagulant) and Coumadin (warfarin, an older anticoagulant), were analyzed in another report. The authors concluded that the most desirable effectiveness, protection, and patient compliance were available to Eliquis.
Keep in mind that only your healthcare provider can take into account the full picture of your:
- Medical condition(s)
- Medical history
- Other drugs you take that might interfere with Eliquis or Xarelto
Ultimately, they can determine the right drug for you!
What is the Cost Comparison of Eliquis vs Xarelto?
You might be wondering: between the cost of Eliquis and Xarelto, how can I choose the most affordable medication?
Here’s the inside scoop.
Usually, Eliquis is covered by insurers and Medicare Part D, but the copays differ greatly. If you pay out-of-pocket, a standard Eliquis prescription for a one-month supply (60 tablets of 5 mg) will cost about $700. For less than $450, you can use a SingleCare card to buy Eliquis.
Insurance and Medicare Part D are typically provided by Xarelto, although the copays differ. For a one-month supply (30 tablets of 20 mg), a standard Xarelto prescription will cost around $620 at the retail price. For around $430, you can use a SingleCare coupon to buy Xarelto.
For Eliquis, a standard dosage is 60 5-milligram tablets with a typical Medicare Part D copay of between $19 and $541. Also, you can get Eliquis for a SingleCare cost of between $447 and $483.
Contrarily, you can get 30 20-milligram tablets of Xarelto for a typical Medicare Part D copay of between $19 and $508. Not only that, but the SingleCare cost for Xarelto is commonly between $428 and $471. Simple as that!
What Are the Side Effects of Eliquis vs Xarelto?
You probably know that most medications have a few side effects, but what are the most common ones experienced after taking Eliquis or Xarelto?
Here’s the breakdown.
Bleeding, such as nosebleeds, contusions (bruising), blood in the urine, or bleeding gums, is the most common side effect of both medications. The occurrence of side effects from bleeding can vary. Bleeding can be extreme or even life-threatening on rare occasions.
In addition to this, tiredness, lack of energy, fatigue, shortness of breath, and nausea are other side effects that can occur with Eliquis.
Besides this, abdominal or back pain, exhaustion, dizziness, itching, anxiety, depression, and insomnia are other side effects that can occur with Xarelto.
Curious about more side effects of these blood thinner medications?
For more information on Eliquis and Xarelto’s adverse reactions, contact your healthcare provider.
What Are the Drug Interactions of Xarelto & Eliquis?
If you are asking yourself about potential drug interactions of Xarelto and Eliquis, then we are here to help you out.
Here’s the thing: some drugs that are metabolized by the same enzyme interact with Eliquis and Xarelto.
So if Eliquis or Xarelto enzyme inhibitor medications are used, the levels of Eliquis or Xarelto in your body will rise, placing you at an elevated risk of bleeding. And if you have to take this mixture of drugs, your doctor will possibly lower your dosage of Eliquis or Xarelto when you are taking both drugs.
On the other side, if the enzyme inducers are taken with Eliquis or Xarelto, there is an effect where Eliquis or Xarelto is metabolized more easily by these medications, and you do not get enough of the dose of Eliquis or Xarelto.
The risk of bleeding can also be increased when using Eliquis or Xarelto with other anticoagulants, antiplatelet medications, NSAIDs (nonsteroidal anti-inflammatory drugs), and some antidepressants. The more you know, right?
What Are the Warnings of Xarelto and Eliquis?
In case you didn’t know, there is a boxed (black box) warning for Eliquis and Xarelto, which is the best warning the FDA needs.
Other alerts include the risk of a clotting incident is increased by discontinuing Eliquis or Xarelto prematurely.
And get this: in patients undergoing neuraxial (between vertebrae) anesthesia or spinal puncture, epidural or spinal hematoma may occur. Long-term or permanent paralysis may result from a hematoma.
But here’s the kicker.
The risk is greater for patients with epidural catheters, patients taking other blood-flow-affecting drugs, patients with a history of traumatic/repeated punctures, and/or patients with a history of or surgery for spinal deformity. Patients should be checked regularly for signs/symptoms of neurological dysfunction (numbness/weakness of the legs, issues with the bowel/bladder) and the patient should seek emergency medical treatment if any problems arise.
Also, bleeding can occur and could be extreme or potentially fatal (major bleeding). The risk of bleeding is increased by the use of Eliquis or Xarelto with some medications (anticoagulants, antiplatelet drugs, NSAIDs, SSRIs, and SNRI antidepressants). Bleeding patients should seek emergency medical treatment.
Have a problem with hemorrhaging?
News flash: in patients with active hemorrhages, the drug should be stopped. Here’s the good news, though. To reverse the effects of the inhibition of factor Xa, a reversal agent is available.
For those of you with prosthetic heart valves, consider this: Eliquis or Xarelto are not recommended. For initial care of PE patients who have hemodynamic instability (shock/heart failure), Eliquis or Xarelto are also not recommended as an alternative to heparin. Due to an increased risk of clotting, Eliquis or Xarelto should not be used in patients with triple-positive antiphospholipid syndrome (APS).
Lastly, before taking Eliquis or Xarelto, talk to your healthcare provider if you have liver or kidney issues!
Should Pregnant Women Take Eliquis or Xarelto?
Here’s where it gets a little confusing. If you are currently pregnant right now, please consider the following facts.
So far, limited data on the use of Eliquis or Xarelto in pregnancy is available. Treatment with Eliquis or Xarelto can increase the risk of both pregnancy and delivery bleeding and increase the risk of fetal/newborn bleeding. Eliquis or Xarelto can cause epidural or spinal hematoma in women receiving an epidural during labor or childbirth.
Here’s the best part, though.
A shorter-acting anticoagulant can be used if needed. So consult your OB-GYN about the use during pregnancy of Eliquis or Xarelto. Generally speaking, the medication is used only if the advantages outweigh the risks (for example, in some high-risk pregnancies) and are monitored closely.
As always, consult your OB-GYN for advice if you are already using Eliquis or Xarelto and learn that you are pregnant.
Know the Difference Between Xarelto vs Eliquis
Still unsure how to tell the difference between Xarelto vs Eliquis?
When it comes to treating your acute venous thromboembolism, we’ve got you covered. Our handy guide has everything you need to make the right decision for you. At the end of the day, trust your doctor’s recommendation at your next primary care appointment.
Want to learn more about taking warfarin?
Don’t hesitate to contact our team of experts today!
[Client-Requested Works Cited]
Internal Links:
External Links:
https://www.ahrq.gov/patients-consumers/diagnosis-treatment/treatments/btpills/btpills.html
https://www.drugs.com/drug-class/factor-xa-inhibitors.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6693001/
https://pubmed.ncbi.nlm.nih.gov/28864318/