Eliquis vs Xarelto: apixaban and rivaroxaban compared
Eliquis (apixaban) and Xarelto (rivaroxaban) are the two most prescribed blood thinners in their class. Both prevent strokes in atrial fibrillation and treat clots, but one is taken twice a day and the other once, their bleeding profiles differ, and only one has a generic reaching pharmacies.
Updated October 3, 2026
At a glance
- How it works
- Eliquis
- Blocks clotting factor Xa
- Xarelto
- Blocks clotting factor Xa
- How often
- Eliquis
- Twice a day, with or without food
- Xarelto
- Once a day for most uses; the higher doses are taken with a meal
- Main uses
- Eliquis
- Stroke prevention in atrial fibrillation, treating and preventing clots, after hip or knee replacement
- Xarelto
- The same, plus a low dose with aspirin for coronary or peripheral artery disease
- Generic available
- Eliquis
- Approved but not yet sold in the US
- Xarelto
- Yes, first in the 2.5 mg strength and during 2026 in other strengths from some makers
- Medicare
- Eliquis
- Medicare-negotiated price in effect since January 2026
- Xarelto
- Medicare-negotiated price in effect since January 2026
Eliquis apixaban | Xarelto rivaroxaban | |
|---|---|---|
| How it works | Blocks clotting factor Xa | Blocks clotting factor Xa |
| How often | Twice a day, with or without food | Once a day for most uses; the higher doses are taken with a meal |
| Main uses | Stroke prevention in atrial fibrillation, treating and preventing clots, after hip or knee replacement | The same, plus a low dose with aspirin for coronary or peripheral artery disease |
| Generic available | Approved but not yet sold in the US | Yes, first in the 2.5 mg strength and during 2026 in other strengths from some makers |
| Medicare | Medicare-negotiated price in effect since January 2026 | Medicare-negotiated price in effect since January 2026 |
Bleeding risk
There is no large head-to-head trial, but observational studies of many thousands of patients have generally found lower rates of major and gastrointestinal bleeding with apixaban than with rivaroxaban. Both raise bleeding risk compared with no anticoagulant, both need dose checks against kidney function, age and weight, and neither should be stopped suddenly without a plan, because that raises the risk of stroke.
Once a day or twice a day
Rivaroxaban’s once-daily dosing is simpler, and its higher doses must be taken with food to be absorbed properly. Apixaban’s twice-daily dosing gives steadier levels, and a missed dose matters less. The schedule a person will actually keep to is a fair consideration in the choice.
Cost
Apixaban is brand-only in the US for now, so cash prices differ between pharmacies only by margin. Rivaroxaban generics have started to reach pharmacies, so for the strengths now available as generics, comparing cash quotes can make a large difference. Medicare-negotiated prices apply to both brands for Part D enrollees.
Questions for your prescriber
- Is my kidney function, age or weight a reason to prefer one?
- Is a generic rivaroxaban available in my strength?
- What should I do if I miss a dose?
- Which of my other medicines interact with it?
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Sources
- DailyMed, FDA-approved prescribing information
- CMS, Medicare drug price negotiation
- MedlinePlus drug information (National Library of Medicine)
- FDA Orange Book (approved generics and therapeutic equivalence)
Written by the Script Unlock editorial team from the sources above. It is general information, not advice for you or your pet; your prescriber decides which medicine is right.
Script Unlock is a marketplace that lets licensed pharmacies quote a cash price on your prescription. It does not prescribe, dispense or sell medication, does not process patient payments, and does not give medical advice. Always follow the instructions of your prescriber and pharmacist and read the medication guide supplied with your medicine.