Eliquis vs. Xeralto

I have been on and off and on Xeralto for several years. I am on it right now. I noticed folks on here seem to favor Eliquis. I did a little research that showed that Eliquis seems to be a little safer. Curious why folks choose one over the other. At the time I just did what the doctor said. I just had my EP appointment but I have a congenital heart doc appointment in a few weeks and I am going to ask him. When I see EP I just see the PA or the NP. (that bothers me but that's another post.) but I get to see my congenital doc face to face... and he might switch me if I ask.

Thanks

The reality is there isn't much difference between Xarelto and Eliquis. If once per day dosing is important to you, choose Xarelto. But you must take Xarelto with a full meal, so if that's a problem, choose Eliquis. If you can get one cheaper than the other, that's another good reason to choose it. Both drugs give you comparable protection when taken properly (remember that full meal thing with Xarelto).

I would imagine any of your doctors would probably switch you if you asked. As for seeing an NP or PA instead of the EP directly, that's pretty standard. It's an extremely rare EP who will handle your daily interactions directly. But honestly, that's not a problem. That NP or PA can handle 90% of your questions just as competently as the EP can, and they'll take the other 10% to the EP for an answer. That's the way medicine works with almost all specialists these days.

I take Xarelto, i like taking it once a day only. As to taking it with a "full meal" I was told you didn't have to take in a lot of food, just some food. I have been on Xarelto for over a year and I take it in the evening and not with a "full meal" I will eat a small amount, perhaps a sandwich, just one slice of bread.

I recommended to my husband that he take Eliquis. My reasoning was that if it is 2 doses a day it must have a shorter half life so could be less dangerous in case of a bleed. He is diligent about taking his meds so I knew that missing a dose was not going to happen, and I knew that either of them would work.

I did no research to test my theory and I realise that it was possibly (probably?) wrong.

Gill

The dosing instructions for Xarelto specifically say to take it with "the evening meal." That means a full mean, not a snack, though a sandwich could be considered a meal.

Surprisingly, Xarelto and Eliquis have similar half lives.

Thanks all.. I may not switch giving what ya'll are saying. It has been working. My one thing that is an issue is this darn hemorrhoid. tmi?? LOL it doesn't hurt but there is bleeding involved. I have had clean colonoscopies. the last one they said come back in 10 "unelss there is a problem." I would love to go off the xeralto- and see if it fixes itself.... I had read maybe eliquis was better for that sort of thing but IDK.

Switching anticoagulants or even stopping them isn't going to help heal a hemorrhoid. It's not bleeding because you're taking Xarelto; it's bleeding because it's not healed. Anticoagulants don't cause bleeding, they only prolong it. So get the hemorrhoid healed and it won't matter what you take because it will stop bleeding and then Xarelto can't prolong the bleeding.

Carey - if they both have similar half lives then why is one a single dose and the other a twice-a-day?

Gill

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Gill
Carey - if they both have similar half lives then why is one a single dose and the other a twice-a-day?

Good question.

As it turns out, Xarelto actually has a shorter half-life than Eliquis (5-9 hours for Xarelto, 12 hours for Eliquis). So how can it be that it only needs once daily dosing while Eliquis requires twice?

It's because the physiological effects of Xarelto last longer than the drug itself. While the effects of Eliquis will be reduced by 50% at 12 hours, the effects of Xarelto will still be active well beyond that time.

It's also worth noting that Xarelto comes in several dosages used for purposes other than afib such as DVT prevention, and some of them do require twice daily dosing.

Anyone who's really interested in the technical nuts and bolts of this can read all about it here.

The case against Xarelto has more to do with it being linked to a slightly higher risk for stomach ulcers. Hence the full meal. I wouldn’t worry too terribly much about it unless you have a history of GI bleeds, in which case I’d request the Eliquis.

It’s not as bad as the Pradaxa, which was much worse for GI bleeds. I don’t think Pradaxa get rx’ed anymore. At least not much.

Thanks Carey, I didn’t know that half-life and physiological effects were different things. So if someone had a bleed would it be better for them to be on Eliquis? And what is the state of play on reversal agents?

Gill

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Gill
Thanks Carey, I didn’t know that half-life and physiological effects were different things. So if someone had a bleed would it be better for them to be on Eliquis? And what is the state of play on reversal agents?

I doubt it would make all that much difference with a bleed whether you're on Xarelto or Eliquis, but I suppose Eliquis would have a slight edge.

There is a reversal agent (Andexxa) that works for both of them. That said, the reality is that NOAC reversal agents are used almost never. I was listening to a discussion about this with a trauma surgeon at NYU Medical Center. He said that he's seen thousands of patients come through his trauma center who are on one of the NOACs, and they have yet to administer a single dose of the reversal agent. That's because by the time you reverse the effects of these drugs they will have largely reversed themselves. It's warfarin that needs a reversal agent because it has such a long half-life (40 hours, and the effects continue for up to 5 days). The NOACs all wear off sufficiently in under 24 hours, so reversing them isn't usually necessary. And if the bleeding is really critical, such as a brain bleed, they can administer fresh frozen plasma in minutes. Andexxa costs between $25,000 and $31,000 per treatment and requires a couple of hours to infuse. So if someone took their Eliquis, say, 8 hours ago and it will take another 2-3 hours to administer Andexxa, you're only shaving about an hour off Eliquis' normal half-life, and it's coming at a cost of over $25K.

I honestly think Andexxa was developed mainly as a sort of placebo. It's meant to make patients feel better about taking NOACs simply because they know it exists even though it's extremely unlikely they'll ever need it or receive it.

How come nobody ever asks about reversal agents for aspirin? It's effect on bleeding can be just as strong as the NOACs, a single dose lasts 5-7 days, and there is no reversal agent. It lasts that long because it disables your platelets permanently, so its effects last until your body replaces all the disabled platelets. But people take aspirin without even thinking about it and consider it a safe drug when it's really anything but. If it were discovered today, it would absolutely be by prescription only.

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Carey

How come nobody ever asks about reversal agents for aspirin? It's effect on bleeding can be just as strong as the NOACs, a single dose lasts 5-7 days, and there is no reversal agent. It lasts that long because it disables your platelets permanently, so its effects last until your body replaces all the disabled platelets. But people take aspirin without even thinking about it and consider it a safe drug when it's really anything but. If it were discovered today, it would absolutely be by prescription only.

So why would multiple Er doctors insist on two baby aspirins when one is taking Eliquis twice a day? All it does is increase my INR and Prothrombin.

I have no idea. I've never had an ER doc recommend aspirin at all, and I'm no stranger to ER cardioversions. You seem to run into a lot of doctors with strange, incorrect opinions.

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Carey
I have no idea. I've never had an ER doc recommend aspirin at all, and I'm no stranger to ER cardioversions. You seem to run into a lot of doctors with strange, incorrect opinions.

No wonder i'm wary of many doctors (and others) advise. Some call me cynical

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wolfpack
The case against Xarelto has more to do with it being linked to a slightly higher risk for stomach ulcers. Hence the full meal. I wouldn’t worry too terribly much about it unless you have a history of GI bleeds, in which case I’d request the Eliquis.

It’s not as bad as the Pradaxa, which was much worse for GI bleeds. I don’t think Pradaxa get rx’ed anymore. At least not much.

Since I’m about to start Xarelto I was looking into this. I saw no mention of avoiding ulcers but what they did discover was that the bioavailability of the 20mg Xarelto is much improved when taken with food. Not so the 10mg. That’s fine either way.

Also taking in the evening is more effective than in the morning