Anticoagulation Therapy with Xarelto and Eliquis

Introduction to Xarelto and Eliquis

The American College of Cardiology notes that there is no direct dosage equivalence between Xarelto (rivaroxaban) and Eliquis (apixaban) due to different pharmacokinetic profiles and dosing regimens, but for atrial fibrillation, rivaroxaban 20 mg once daily is generally considered therapeutically equivalent to apixaban 5 mg twice daily 1

Apixaban has a half-life of 12 hours, while rivaroxaban has a half-life of 5-9 hours, according to the American College of Cardiology 1
Rivaroxaban has a bioavailability of 60-80%, as stated by the American College of Cardiology 1
Apixaban is excreted 27% renally and 73% via biliary and intestinal routes, whereas rivaroxaban is excreted 66% renally and 28% via feces, as reported by the American College of Cardiology 1

The standard dose of rivaroxaban is 20 mg once daily, with a reduced dose of 15 mg once daily for patients with CrCl 15-50 mL/min, as recommended by the American College of Cardiology 1
The standard dose of apixaban is 5 mg twice daily, with a reduced dose of 2.5 mg twice daily if the patient has at least 2 of the following: age ≥80 years, weight ≤60 kg, or serum creatinine ≥1.5 mg/dL, according to the American College of Cardiology and Praxis Medical Insights 1, 2

When switching from rivaroxaban to apixaban, discontinue rivaroxaban and start apixaban at the time the next rivaroxaban dose would have been taken, as advised by the American College of Cardiology 1
When switching from apixaban to rivaroxaban, discontinue apixaban and start rivaroxaban at the time the next apixaban dose would have been taken, as advised by the American College of Cardiology 1

For elective procedures with significant bleeding risk, apixaban should be discontinued 48 hours before the procedure, as recommended by Praxis Medical Insights 2
For elective procedures with significant bleeding risk, rivaroxaban should be discontinued 48 hours before the procedure, as recommended by Praxis Medical Insights 2
For procedures with low bleeding risk, both medications can be discontinued 24 hours before the procedure, as stated by Anaesthesia 3

The choice between rivaroxaban and apixaban should be based on clinical factors such as renal function, bleeding risk, medication adherence, and comorbidities, rather than attempting to find a direct dosage equivalence, as suggested by the American College of Cardiology 1