When You Can't Find Apixaban, You Still Need Protection

If you're one of the millions of Americans who takes Apixaban (brand name: Eliquis) to prevent blood clots or reduce the risk of stroke, you know that missing doses isn't an option. This medication is keeping you safe — and going without it, even for a few days, can put you at serious risk.

But what happens when your pharmacy is out of stock? When you've called around and nobody has it? You need a backup plan — and that means understanding what alternatives exist and having a conversation with your doctor.

This guide walks you through the most common alternatives to Apixaban, how they compare, and what to discuss with your prescriber.

What Is Apixaban and How Does It Work?

Apixaban is a direct oral anticoagulant (DOAC) that belongs to the Factor Xa inhibitor class. It works by selectively blocking Factor Xa, a key protein in the blood clotting process. By inhibiting this protein, Apixaban prevents the formation of blood clots that can cause strokes, deep vein thrombosis (DVT), and pulmonary embolism (PE).

Compared to older blood thinners, Apixaban has several advantages:

• No regular blood monitoring required (unlike Warfarin)
• Fewer dietary restrictions
• Predictable dosing
• Lower risk of major bleeding in many studies

For a deeper dive, read our full guide on how Apixaban works.

Alternative 1: Rivaroxaban (Xarelto)

Rivaroxaban, sold as Xarelto, is the closest alternative to Apixaban. It's also a Factor Xa inhibitor and works through a very similar mechanism.

Key differences from Apixaban:

• Dosing: Rivaroxaban is usually taken once daily (compared to Apixaban's twice daily), which some patients find more convenient. However, it must be taken with food for proper absorption.
• Bleeding risk: Clinical studies suggest Apixaban may have a slightly lower risk of major bleeding compared to Rivaroxaban, particularly gastrointestinal bleeding. However, both are considered safe and effective.
• Availability: Generic Rivaroxaban is also available, and it may be easier to find at your pharmacy than Apixaban depending on local supply conditions.
• Cost: Brand-name Xarelto costs around $500–$550/month. Generic Rivaroxaban may be available for $30–$100/month.

Rivaroxaban is FDA-approved for the same major indications as Apixaban, including stroke prevention in AFib and treatment of DVT/PE.

Alternative 2: Warfarin (Coumadin)

Warfarin has been the standard blood thinner for decades. It's a vitamin K antagonist that works differently from Apixaban — instead of directly blocking Factor Xa, it interferes with the production of multiple clotting factors in the liver.

Key differences from Apixaban:

• Monitoring: Warfarin requires regular blood tests (INR checks), typically every 1–4 weeks, to make sure your blood is at the right level of thinness. This is the biggest drawback compared to DOACs like Apixaban.
• Diet: You need to maintain consistent vitamin K intake (found in green leafy vegetables), as it directly affects how the drug works.
• Drug interactions: Warfarin interacts with many more medications than Apixaban. Check out our guide on Apixaban drug interactions for comparison.
• Cost: Warfarin is extremely cheap — as low as $4–$10/month. If cost is a factor, this may be relevant.
• Reversibility: Warfarin can be reversed with vitamin K, which is widely available at every hospital.

While Warfarin has more monitoring requirements, it's a proven medication with decades of clinical data. For some patients, it remains the best choice — especially those with mechanical heart valves (where DOACs are not recommended).

Alternative 3: Dabigatran (Pradaxa)

Dabigatran, sold as Pradaxa, takes a different approach from Apixaban. Instead of blocking Factor Xa, it directly inhibits thrombin (Factor IIa), another key protein in the clotting process.

Key differences from Apixaban:

• Dosing: Taken twice daily, similar to Apixaban.
• GI side effects: Dabigatran is more likely to cause stomach upset and heartburn than Apixaban.
• Reversal agent: Dabigatran has a specific reversal agent called Idarucizumab (Praxbind), which can completely reverse its effects within minutes in case of emergency bleeding. Apixaban's reversal agent, Andexanet Alfa (Andexxa), is available but much more expensive and less widely stocked.
• Storage: Dabigatran capsules must be kept in their original bottle and used within 4 months of opening. They should not be placed in pill organizers.
• Cost: Brand Pradaxa costs around $450–$500/month. Generic Dabigatran is available for approximately $40–$80/month.

Alternative 4: Edoxaban (Savaysa)

Edoxaban, sold as Savaysa, is another Factor Xa inhibitor similar to Apixaban.

Key differences from Apixaban:

• Dosing: Once daily, which is convenient.
• Initial therapy: For DVT/PE treatment, Edoxaban requires 5–10 days of initial treatment with an injectable anticoagulant (like Heparin or Enoxaparin) before starting. Apixaban does not require this.
• Kidney function: Edoxaban should not be used in patients with very good kidney function (CrCl >95 mL/min), as it was less effective than Warfarin in this group during clinical trials.
• Cost: Brand Savaysa costs around $400–$450/month. Generic availability is limited as of 2026.

Important: Do Not Switch on Your Own

While these alternatives are all effective blood thinners, you should never switch medications without your doctor's guidance. Each drug has different dosing, different drug interactions, and different considerations based on your specific health conditions.

If you can't find Apixaban:

1. Contact your doctor or prescriber immediately
2. Explain that you're unable to fill your prescription
3. Ask about temporary alternatives or bridge therapy
4. Use Medfinder to check if any nearby pharmacies have Apixaban in stock

Your doctor will consider your kidney function, other medications, bleeding risk, and specific diagnosis when choosing an alternative.

Final Thoughts

Running out of your blood thinner is stressful, but you have options. Rivaroxaban, Warfarin, Dabigatran, and Edoxaban are all proven alternatives that your doctor can prescribe if Apixaban isn't available.

The key is acting quickly. Don't wait until you've missed several doses to reach out. If you're having trouble finding Apixaban, start with Medfinder to locate it near you. If that doesn't work, call your doctor that same day to discuss your options.

For the latest on supply conditions, read our Apixaban shortage update for 2026.