Apixaban Vs Rivaroxaban – Comparison of Two DOACs

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apixaban vs rivaroxaban a head to head comparison

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 the 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].

For a comprehensive article on Apixaban: Apixaban (Eliquis) – Uses, Dose, Side effects

For a comprehensive article on Rivaroxaban: Rivaroxaban (Xarelto, Roxarel, Rivoban) – Drug Information

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