Xarelto vs Eliquis: How do they compare?

Xarelto (rivaroxaban) and Eliquis (apixaban) are novel anticoagulants that make blood less likely to clot. Both belong to the class of medicines known as factor Xa (FXa) inhibitors and they are two of the most popular blood thinners on the market. Either one may be used to reduce the risk of stroke or treat and prevent blood clots in conditions such as DVT.

Xarelto was first approved in 2012 and Eliquis was first approved in 2011.

What is the cost of Eliquis vs Xarelto?

The average cost of Eliquis is around $550 for a month’s supply, which is the same as Xarelto. Both Eliquis and Xarelto are significantly more expensive than warfarin which is also used to prevent blood clotting (warfarin costs around $19 per month).

There is a generic version of Eliquis that has been approved but it is not commercially available and recently the makers of Eliquis, Bristol Myers Squibb, were able to extend their patent till 2026. There is no approved generic of Xarelto. The patent for Xarelto lasts until 2039.

Are there any differences in effectiveness between Eliquis Vs Xarelto?

Two large retrospective studies (78,702 patients [Study 1] + 581,451 patients [study 2]) have found that overall, Eliquis appears to be more effective than Xarelto.

• Study 1 showed Eliquis to be significantly more effective than Xarelto at reducing the risk of stroke or systemic embolism (6.6 events per 1000 patient-years with Eliquis compared with 8 events per 1000 patient-years with Xarelto).

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Are there any differences in side effects between Eliquis Vs Xarelto?

Two large retrospective studies (78,702 patients [Study 1] + 581,451 patients [study 2]) have found that overall, Eliquis appears to be safer than Xarelto.

• Eliquis was associated with a significantly lower incidence of major bleeding (which was defined as gastrointestinal bleeding or intracranial hemorrhage) with Eliquis patients experiencing 12.9 bleeding events per 1000 patient years and Xarelto patients experiencing 21.9 bleeding events per 1000 patient-years (Study 1)
• This was confirmed by study 2 with significantly fewer fatal extracranial bleeding events reported with Eliquis compared with Xarelto (1.0 vs 1.4 per 1000 person-years), as well as significantly fewer nonfatal extracranial bleeding events (18.5 vs 39.7 per 1000 person-years)
• Overall mortality was also lower with Eliquis compared with Xarelto (41 vs 44.2 events per 1000 person-years respectively).

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