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AF Association
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Rivaroxaban vs Apixaban

Hello, can anyone tell me what's the pros and cons are relating to Rivaroxaban and Apixaban please?

In Particular which is the most effective stroke prevention?

Which has the least side effects?

Thank you

21 Replies

Hi plainjane

it's not that simple to be honest, the stroke prevention is almost exactly the same in all the NOACs, rivaraxiban is of course once a day, but with the lack of a reversal agent that means a longer half life in your body.

I take rivaroxaban, and I have the original "cast iron stomach" I eat street food all over Asia with never a problem, but the first few weeks on Rivaroxaban, I had awful stomach aches.

Otheres have no problems at all we are all different.

It has to be take WITH food, ideally not before or after, and that means eating at the same time each day which I also find not ideal.

You need to talk to a clued up EP and ask their advice taking into account your mother's other drugs and challenges.

Be well



Ian is right but I believe that Apixaban has a slightly lower risk of intercranial bleeds than Rivaroxaban which is why it is preferred for older patients. Not medically trained so I could be wrong.


Maybe this will help, a video titled The best NOAC for AF by Dr Sanjay Gupta...



This was extremely helpful


Going to GP on Friday to discuss a change from Warfarin to NOAC. Really helpful. Thanks



Fairly new to this so would be grateful know what is NOAC.


New (or novel) oral anticoagulant - alternatives to Warfarin. As the very helpful video above states there are four: Apixaban (Eliquis) Rivaroxaban (Xarelto) Dabigitran (Praxada) and Edoxaban (Lixiana). Some are not so very new any more. They don't work in the same way as Warfarin which has the disadvantage of requiring regular blood checks as it is affected by all sorts of things including foods that contain Vitamin K. The NOACs work effectively all the time provided they are taken regularly.


Thank you Rellim296


Very helpful, thank you for posting this!


Dr Gupta's videos are brilliant.

I have been taking dabigatran/Pradaxa for nearly 2 years. If you were to take it then you need to avoid antacids. Pradaxa needs an acid stomach. Once I had binned the antacid tablets prescribed with the Pradaxa I was fine. ( eternal thanks to CDreamer for her advice about this )

It helps to Google the individual medications for guidelines. When I did this I could see that Pradaxa needed an acid environment.


Could you please clarify regarding antacids. My EP said it was OK to take ranitidine. Is this incorrect?


You can certainly take it but it may make your stomach less acid which, in my experience does not suit the Pradaxa. Whilst I was taking the antacid my stomach felt most uncomfortable and since I stopped taking it the Pradaxa has suited me perfectly.

We're all different. What suits one doesn't suit another. I had always thought that my stomach was bomb-proof. Certainly I had never needed an antacid before they prescribed it along with the Pradaxa.


I was kind of thinking the ranididine would help prevent Pradaxa based stomach upset. I haven't had much, just the occasional gurgling, but you make sense.

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I have been talking Apixaban for 8 months for treating both the AF and a DVT clot. I have had no side affects at allover this time. I haven't really had to change my diet while the exception of limiting certain green vegetables and alcohol.


I have just started taking Apixaban, so far with no side effects, but I had no idea that either green vegetables or alcohol interacted with the drug. Please could GazzaD57 clarify this point. Thank you.


Same here I have just checked in the apixaban booklet and no food interactions are mentioned just " certain meficines and supplements " x


When I started taking Apixaban two and a half years ago, the hospital told me not to take anti-inflammatory medication, aspirin based products or anything containing St John's wort. There is no limit on green vegetables but alcohol may be ill-advised for some people because of their AF and other cardiac conditions. Moderation was recommended to me on starting Apixaban.


I was on Warfarin for five years before changing to Rivaroxaban two years ago. I recall being hospitalized several years ago while on Warfarin after surgery. I had difficulty being discharged because they could not get my INR levels stabilised. Maybe I'm wrong - but the aforementioned difficulty might be simplified and not reoccur now that I'm taking Riveroxaban.


The green vegetables part is because the vitamin K in them interferes with Warfarin.


Agreed, but the NOACs don't have that limitation.


I have been on Apixoban for 6 weeks now. During the first fortnight I had a few mild dizzy spells, however these have stopped and I now feel fine.

I drink alcohol, not every day, but when I do its usually red wine, or the occasional gin and tonic, and I eat loads of vegetables.

Hope that helps


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