Eliquis or Xarelto: Which One Might Be Right for You?

Every dose decision below belongs to your prescriber. The table describes what the labels say in general terms, not what you should take.

Neither medicine is recommended for people with prosthetic heart valves (FDA, 2012; FDA, 2018). Both carry warnings about blood clots forming near the spine if you have epidural or spinal anesthesia or a spinal injection while taking them (MedlinePlus, 2025; FDA, 2018) — tell any anesthesiologist, surgeon or dentist which anticoagulant you are on.

These are examples of how prescribers reason, not rules, and they are not diagnoses. Guidance also varies by country and by which edition of a professional guideline your clinician follows, so a cardiologist in the US may frame the trade-offs differently from one elsewhere.

If a person has reduced kidney function, a doctor may weigh the two differently, because both drugs are partly cleared by the kidneys and each label uses a different measure to decide the amount — a kidney blood test combined with age and body weight for apixaban (FDA, 2012), and calculated creatinine clearance for rivaroxaban (FDA, 2018). Blood tests over time may shift that judgement.

If a person has a history of bleeding from the stomach or bowel, a doctor may consider how each drug behaves in the gut and what else the person takes, since bleeding is the most common adverse reaction reported with both (FDA, 2012; FDA, 2018) and active pathological bleeding is a contraindication for apixaban (FDA, 2012).

If a person has difficulty keeping to a twice-daily routine, or eats on an irregular schedule, a doctor may consider which schedule fits better — apixaban is taken twice daily (MedlinePlus, 2025), while rivaroxaban's labeled schedule depends on the reason for treatment and, for some uses, is tied to a meal (FDA, 2018). Cost and what your insurance covers often come into the same conversation; ask your pharmacist what each would cost you before the prescription is written.

If you think one of these situations describes you, bring it up as a question rather than a request for a named drug.

Report these to your care team; do not read them as a conclusion about what is happening in your body.

• Both drugs — bleeding of any kind. This is the most commonly reported adverse reaction for each (FDA, 2012; FDA, 2018).
• Both drugs — slower-stopping bleeding after a cut, and easier bruising. Apixaban's patient information notes it may take longer for bleeding to stop and that you may bruise or bleed more easily (MedlinePlus, 2025); the same practical caution applies to rivaroxaban as an anticoagulant.
• Both drugs — bleeding gums, frequent nosebleeds, or heavy vaginal bleeding. Listed for apixaban as needing immediate medical attention (MedlinePlus, 2025); treat these as prompt call-your-doctor-now situations on either drug.
• Both drugs — red, pink or brown urine, or red or black tarry stools. Also on the apixaban list requiring immediate attention (MedlinePlus, 2025). Call your doctor the same day.
• Both drugs — coughing up or vomiting blood, or material that looks like coffee grounds. Go to an emergency department or call 911; do not wait for an office appointment (MedlinePlus, 2025).
• Both drugs — numbness, tingling, weakness in the legs or trouble controlling the bladder or bowels after spinal or epidural anesthesia or a spinal injection. Both labels warn about clots or blood collecting near the spine, which can cause paralysis (MedlinePlus, 2025; FDA, 2018). This is emergency care, not a next-appointment item.
• Apixaban specifically — severe allergic-type reaction. Severe hypersensitivity to apixaban is a contraindication in the label (FDA, 2012). Trouble breathing, facial swelling or hives is emergency care.
• Rivaroxaban specifically — the label notes an agent is available to reverse its anti-factor Xa activity in a bleeding emergency (FDA, 2018), which is a detail hospital teams use rather than a side effect you would notice.
• Both drugs — a sharp rise in clot risk if doses are missed or the drug is stopped. Both carry boxed warnings about premature discontinuation (FDA, 2012; FDA, 2018). Call your doctor or pharmacist if you miss doses or run out — do not simply stop.