Can you switch from Xarelto (rivaroxaban) to Eliquis (apixaban)?
Yes, but you generally switch using the timing of your next scheduled dose, not a “washout” period. Both drugs are direct oral anticoagulants (DOACs), so the goal is to keep anticoagulation continuous while avoiding a gap that increases clot risk or an overlap that increases bleeding risk.
The exact instructions depend on why you take anticoagulation (for example, atrial fibrillation vs. treatment of a clot such as DVT/PE) and your current Xarelto dose.
How should the switch be timed if you take Xarelto once daily vs twice daily?
- If you are taking Xarelto once daily (common in atrial fibrillation), clinicians typically start Eliquis at the time the next Xarelto dose would be due.
- If you are taking Xarelto twice daily (common in the initial treatment phase for DVT/PE), the switch timing is often tied to when the next scheduled Xarelto dose would occur, so you can start Eliquis without missing anticoagulant effect.
Because “once daily vs twice daily” can map to different dosing regimens and indications, your prescriber should confirm the specific transition schedule for your situation.
What Eliquis dose is usually used when switching?
Eliquis dosing depends on the indication and patient factors (especially for atrial fibrillation). A common atrial fibrillation regimen is apixaban 5 mg twice daily, with dose reduction in certain patients. For clot treatment, dosing starts higher and then reduces after a set period.
So the “right” Eliquis dose after switching is not determined by the switch itself, but by whether you’re being treated for atrial fibrillation or for DVT/PE, and by your age, kidney function, and (for AF) other criteria.
What changes if you’re switching for atrial fibrillation vs treating a blood clot?
Atrial fibrillation
- The focus is consistent stroke prevention dosing on a twice-daily schedule.
DVT/PE treatment
- The initial and maintenance dosing phases matter. Switching into the correct Eliquis phase (initial vs maintenance) is important, and the timeline can depend on how long you’ve already been on Xarelto.
Do you need blood tests during the switch?
Routine monitoring is not usually required for DOAC switching (unlike warfarin). However, clinicians often check kidney function and review bleeding risk factors before and during DOAC use, because kidney function affects drug exposure and safety.
What are the main safety risks during a switch?
The two practical risks are:
- Missing doses (too much clot risk if anticoagulation drops)
- Overlapping anticoagulant effect (too much bleeding risk if doses are stacked)
That’s why the safest transitions usually start Eliquis when the next Xarelto dose would be due, rather than changing schedules mid-day.
When should you avoid switching without medical guidance?
Don’t switch without guidance if any of these apply:
- You’ve had recent major bleeding
- You have severe kidney disease or rapidly changing kidney function
- You’re within a high-risk early period of clot treatment and your Xarelto regimen is being actively titrated
- You’re taking interacting drugs (some can raise or lower DOAC levels)
Practical step: what to ask your clinician or pharmacist
Bring your prescription labels or dosing schedule and ask:
- “I take Xarelto at what times and at what dose. Exactly what time should I start Eliquis?”
- “Is this switch for atrial fibrillation or for DVT/PE treatment, and which Eliquis dose should I use (initial vs maintenance)?”
- “Do I need any kidney function tests before switching?”
If you tell me your exact Xarelto dose (e.g., 20 mg once daily, 15 mg once daily, or 10/15/20 mg twice daily depending on indication), what you’re taking it for, and when your next dose is due, I can help map out the most common “start Eliquis at the next scheduled dose time” approach and what dosing questions to confirm with your prescriber.