Apixaban Vs Rivaroxaban - Which directly acting oral anticoagulant do you prefer? Which one should you choose? Well, before choosing any anticoagulant, you should know the key differences between the two. A head-to-head comparison is given here to understand the major differences between the two directly acting oral anticoagulants.
Apixaban Vs Rivaroxaban - A comparison of two directly acting oral anticoagulants:
Brand Names:
- Apixaban:
- Eliquis
- Rivaroxaban:
- Xarelto
- Roxarel
- Rivaxa
- Rivarox
- Rivoban
- Xcept
Formulations:
- Apixaban:
- Oral Tablets in doses of 2.5 mg and 5 mg
- Rivaroxaban:
- Oral Tablets in doses of 2.5 mg, 5 mg, 10 mg, 15 mg, and 20 mg
Dosing Frequency:
- Apixaban:
- Twice a day
- Rivaroxaban:
- Once a day
Mechanism of action:
- Apixaban:
- It directly, reversibly, and selectively inhibits both clot-bound and free factor Xa.
- Rivaroxaban:
- It blocks Factor Xa directly and reversibly
Absorption:
- Apixaban:
- It is absorbed rapidly with the onset of action in 3 to 4 hours
- Rivaroxaban:
- It is rapidly absorbed with the onset of action within 15 - 30 minutes.
The Time to Peak Serum Concentration:
- Apixaban:
- It takes 3 - 4 hours for the drug to reach the peak serum concentration
- Rivaroxaban:
- It takes 2 - 4 hours for the drug to achieve peak serum concentration.
How to administer?
- Apixaban:
- It may be taken without regard to meals
- Rivaroxaban:
- It should be taken with meals.
What is the antidote in case toxicity occurs?
- Andexanate - Alfa can be used to reverse the effects of both drugs immediately in case of toxicity.
- Absorption of the drug can also be prevented by activated charcoal.
- Alternatively, prothrombin concentrate can be used in situations where andexanate alfa is not available.
Does weight affect the dose?
- Apixaban:
- It can be used in obese and overweight individuals.
- Rivaroxaban:
- It is not indicated in obese individuals who weigh more than 120 kgs or have a BMI of 40 kg/m2 or more.
Use in patients with kidney disease:
- Apixaban:
- Apixaban can be safely used in patients with kidney disease including patients on hemodialysis.
- Rivaroxaban:
- Rivaroxaban is not recommended in patients with a CrCl of less than 30 ml/minute and should be used with caution in patients with a CrCl of less than 50 ml/minute.
Comparison of Safety of the Apixaban vs rivaroxaban:
- Compared to Rivaroxaban, Apixaban is associated with few serious adverse side effects. Patients on rivaroxaban are at a greater risk of intracranial and gastrointestinal bleeding compared to apixaban [Ref].
Comparison of the efficacy of Apixaban vs rivaroxaban:
- Recent data is more in favor of apixaban in preventing systemic embolization and strokes in patients with non-valvular atrial fibrillation.
Comparison of the efficacy of Apixaban vs rivaroxaban in cancer patients:
- Compared to Apixaban, Rivaroxaban was associated with lower mortality and higher incidences of clinically relevant non-major bleeding [Ref].
