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Eliquis (apixaban) is a direct oral anticoagulant (DOAC) that works by inhibiting factor Xa, a key protein in the blood clotting process. It is primarily prescribed to prevent strokes in people with non-valvular atrial fibrillation (NVAF), treat deep vein thrombosis (DVT) and pulmonary embolism (PE), and reduce the risk of recurrent clots. Additionally, Eliquis is used to prevent DVT and PE in patients undergoing hip or knee replacement surgery.

Common side effects of Eliquis include minor bleeding episodes such as heavy menstrual bleeding, gum bleeding, and bruising. Serious side effects, though rare, can include internal bleeding, anemia, or allergic reactions.

The cost of Eliquis for a 30-day supply in the US is $594 (list price). Although the FDA approved a generic version of Eliquis in 2019, it might not become available on the market until 2028. In emergencies involving life-threatening bleeding, the effects of Eliquis can be reversed with Andexxa (andexanet alfa).

Eliquis is preferred over older anticoagulants like warfarin because it does not require routine blood monitoring or dietary restrictions. However, when Eliquis is not suitable due to cost, availability, or medical considerations, various effective Eliquis alternatives are available to address blood-thinning needs.

Key Takeaways

  • An effective alternative to Eliquis, Pradaxa has a faster onset of action and a reversal agent (Praxbind). However, it carries a higher risk of gastrointestinal issues and major bleeding.
  • The oldest anticoagulant, Warfarin is inexpensive, widely available, and suitable for patients with mechanical heart valves or thrombotic antiphospholipid syndrome. However, it requires regular INR monitoring and has dietary restrictions.
  • While Savaysa is effective for stroke prevention, it has a higher risk of major bleeding in elderly patients (80+).
  • Lovenox’s rapid onset of action makes it suitable for emergency situations, such as the immediate treatment of DVT or PE.
  • Fragmin remains the gold standard for treating blood clots in cancer patients, with studies showing a lower risk of non-major bleeding compared to Eliquis.
  • Xarelto is the only Eliquis alternative that is FDA-approved for reducing blood clots in patients with coronary artery disease (CAD) and peripheral artery disease (PAD).

6 Eliquis Alternatives for Stroke and Blood Clot

Several alternatives to Eliquis are available, each with distinct characteristics:

1. Pradaxa

Pradaxa capsules, an eliquis alternative

Active ingredients: Dabigatran

Drug class: Direct thrombin inhibitor

Dosage form and strength: 75 mg, 110 mg and 150 mg capsules

Dosage frequency: Twice daily

Approved indications: 

    • Reduces stroke and blood clot risk in adults with NVAF.
    • Treats DVT and PE in adults after 5-10 days of injectable blood thinners.
    • Lowers the chance of DVT and PE returning in adults who have already been treated.
    • Prevents DVT and PE after hip replacement surgery in adults.
    • Treats blood clots in children (8-17 years) after at least 5 days of injectable blood thinners.
    • Reduces the risk of blood clot recurrence in children (8-17 years) who have been treated before.

Common side effects: Bleeding and gastrointestinal side effects.

PROS:

  • Cheaper than Eliquis
  • Equally effective as Eliquis in stroke and blood clot prevention
  • Faster onset of action (0.5 to 2 hours)
  • Approved in pediatric patients for risk reduction of blood clot recurrence
  • Less drug-drug interaction
  • Has available reversal agent (Praxbind)

CONS:

  • More likely to cause stomach upset, acid reflux, and other gastrointestinal issues
  • Higher risk of major bleeding
  • Higher risk of gastrointestinal bleeding

In a direct comparison conducted in 2016, both Eliquis and Pradaxa were equally effective in preventing strokes or blood clots. However, Eliquis was associated with a lower risk of major bleeding, making it a safer option than Pradaxa.

In a more recent study, similar results were observed. Both Eliquis and Pradaxa were effective in preventing strokes or systemic embolism (serious blood clots), but Eliquis demonstrated the best overall safety profile, particularly for major bleeding events.

In certain groups, such as patients with diabetes or those taking digoxin, Eliquis showed slightly higher mortality risks compared to Pradaxa. This suggests that patients with diabetes or those on digoxin may benefit more from Pradaxa.

Before You Make the Switch!

Make an informed decision with the facts you need! Learn more about their differences in effectiveness, safety, and dosing in our detailed article on Eliquis vs Pradaxa.

2. Savaysa

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Active ingredients: Edoxaban

Drug class: Factor Xa inhibitor

Dosage form and strength: 60 mg, 30 mg, and 15 mg tablets

Dosage frequency: Once daily

Approved indications: 

    • Reduces the risk of stroke and systemic embolism in patients with NVAF.
    • Treat blood clots in the legs (DVT) or lungs (PE) after 5-10 days of treatment with an injectable blood thinner.

Common side effects: Bleeding, rash, abnormal liver function tests, and anemia.

PROS:

  • Taken once daily
  • Less expensive
  • As effective as Eliquis and even slightly better at reducing stroke/clot risks in some studies
  • Similar risk of bleeding as Eliquis in general populations
  • Showed similar mortality rates to Eliquis in patients aged 80 and older

CONS:

  • Not suitable for patients with a creatinine clearance (CrCL) more than 95 mL/min due to an increased risk of stroke
  • Fewer FDA-approved indications
  • Does not have a dedicated reversal agent
  • Higher risk of major bleeding in elderly patients
  • Requires bridging when used for the treatment of DVT or PE (5-10 days)

In real-world data from Germany, Savaysa showed a similar risk of major bleeding as Eliquis and even had a slightly lower risk of stroke or serious blood clots. These findings are consistent with a meta-analysis of 17 studies, which also found that Savaysa had a slightly lower risk of stroke or serious blood clots compared to Eliquis. Moreover, both drugs demonstrated similar risks of bleeding events.

In studies focusing on older adults (80 years and older) with nonvalvular atrial fibrillation, both drugs were equally effective at preventing stroke and blood clots. However, Savaysa was associated with a higher risk of major bleeding compared to Eliquis, while both had similar death rates.

For elderly patients, Savaysa may not be the best alternative to Eliquis for AFib due to the risk of major bleeding.

3. Xarelto

Xarelto tablets, alternatives to eliquis for afib

Active ingredients: Rivaroxaban

Drug class: Factor Xa inhibitor

Dosage form and strength: 2.5 mg, 10 mg, 15 mg, and 20 mg tablets

Dosage frequency: Once or twice daily, depending on the condition

Approved indications:

    • Prevents strokes and blood clots in adults with non-valvular atrial fibrillation.
    • Treats deep vein thrombosis (DVT).
    • Treats pulmonary embolism (PE).
    • Reduces the chance of DVT or PE coming back.
    • Prevents DVT and PE after knee or hip replacement surgery.
    • Prevents blood clots in hospitalized patients who are seriously ill.
    • Lowers the risk of heart-related events in people with coronary artery disease (CAD).
    • Reduces major blood vessel clots in people with peripheral artery disease (PAD), including after leg surgeries.
    • Treats blood clots and prevents recurrence in children under 18 years old.
    • Prevents blood clots in children (2+ years) with congenital heart disease after Fontan surgery.

Common side effects: Bleeding, cough, vomiting, and gastroenteritis.

PROS:

  • Offers once-daily dosing for some conditions
  • Wider range of indications
  • Effective stroke and blood clot prevention
  • Shares the same reversal agent with Eliquis (Andexxa)

CONS:

  • One of the most expensive anticoagulants
  • Must be taken with food for proper absorption (in some conditions)
  • Higher risk of major bleeding, including bleeding in the brain
  • Higher overall mortality rate compared to Eliquis, making it less favorable for high-risk patients

Multiple studies show that Eliquis and Xarelto are safe and effective in preventing strokes and blood clots. However, Eliquis often has a slight edge.

For example, a study in older patients (65+) with atrial fibrillation (afib) found that patients on Xarelto had a higher risk of stroke or blood clots. In adults, Eliquis reduced the risk of stroke and blood clots by 18% compared to Xarelto.

Regarding their safety profile, Xarelto had a higher rate of major bleeding than Eliquis (7.5 vs. 5.9 events per 1000 person-years), including fatal bleeding and intracranial hemorrhage. A meta-analysis also confirmed that Eliquis significantly reduced the risk of major bleeding and gastrointestinal bleeding compared to Xarelto.

Want to Learn More?

If you’re switching from Xarelto to Eliquis or vice versa, or just want to understand the difference between Eliquis and Xarelto, we’ve got the answers. Explore our full breakdown in Xarelto vs Eliquis for essential details.

4. Warfarin

Warfarin tablets as an Eliquis alternative

Active ingredients: Warfarin

Drug class: Vitamin K antagonist

Dosage form and strength: 1 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg, and 10 mg tablets

Dosage frequency: Once daily

Approved indications:

    • Prevention and treatment of DVT and PE.
    • Prevention and treatment of blood clots in people with atrial fibrillation.
    • Prevention and treatment of blood clots in people with heart valve replacements.
    • Reduce the risk of death, repeat heart attacks, and blood clots after a heart attack.

Common side effects: Bleeding and gastrointestinal side effects.

PROS:

  • Taken once daily
  • Widely available and much cheaper than Eliquis
  • Long history of use
  • Can be used in patients with heart valve replacements
  • Broader range of approved uses
  • Can be easily reversed using vitamin K or fresh frozen plasma

CONS:

  • Requires regular blood monitoring (INR testing)
  • Specific dietary restrictions, especially foods high in vitamin K (like spinach and broccoli)
  • Interacts with many medications, including herbal supplements like Ginkgo Biloba or Asian Ginseng
  • Takes several days to reach full effect
  • Higher risk of bleeding

Warfarin is one of the oldest anticoagulants and is still widely used today. It was first developed in the 1920s as a rodent poison and later approved for medical use in humans in the 1950s. Modern direct oral anticoagulants like Eliquis and Xarelto are newer alternatives developed in the 2000s.

While Eliquis has taken the lead in many areas of anticoagulation therapy due to its safety, convenience, and effectiveness, there are specific situations where warfarin is the better choice. For instance:

    • Prosthetic Heart Valves: Warfarin is the standard treatment for patients with mechanical heart valves. Eliquis, on the other hand, is not recommended for this use according to its prescribing information.
    • Thrombotic Antiphospholipid Syndrome (TAPS): Studies suggest that for patients with TAPS, a condition that causes abnormal clotting, warfarin has shown better effectiveness than Eliquis.

5. Lovenox

Lovenox syringes as an alternative to Eliquis

Active ingredients: Enoxaparin

Drug class: Low molecular weight heparin

Dosage form and strength: 100 mg/mL concentration (available in single-dose prefilled syringes, single-dose graduated prefilled syringes, and multiple-dose vial) and 150 mg/mL concentration (available in single-dose graduated prefilled syringes)

Dosage frequency: Once or twice daily injection, depending on the condition.

Approved indications: 

    • Prevents blood clots after surgeries (abdominal, hip, or knee replacement).
    • Prevents blood clots in bedridden patients during severe illness.
    • Treats blood clots in the legs (DVT), with or without lung clots (pulmonary embolism).
    • Reduces heart risks in chest pain (unstable angina) or mild heart attacks (non–Q-wave MI).
    • Treats serious heart attacks (STEMI), with or without artery-opening procedures (PCI).

Common side effects: Bleeding, anemia, low platelet count, elevation of liver enzymes, diarrhea, nausea, bruising, fever, swelling, shortness of breath, confusion, and injection site pain.

PROS:

  • Has generic alternatives
  • Broader range of approved uses
  • Works almost immediately (5 to 10 minutes) when injected directly into a vein (intravenously)
  • Long history of use

CONS:

  • Requires injections (intravenous or subcutaneous)
  • Contraindicated to individuals allergic to pork products and benzyl alcohol
  • Associated with more side effects
  • No specific reversal agent, but partial reversal may be achieved with protamine sulfate (60% reversal)
  • Higher bleeding risk
  • Higher monthly costs (up to $970 in the US), but a generic version could reduce expenses.

Eliquis generally demonstrates greater efficacy and safety compared to older drugs like Lovenox. In the ADVANCE-2 trial, Eliquis was more effective than Lovenox in preventing VTE after knee replacement surgery, and in the ADVANCE-3 trial, Eliquis outperformed Lovenox in preventing VTE after hip replacement surgery.

In emergency situations, such as the immediate treatment of DVT or PE, Lovenox is often preferred due to its faster onset of action when administered intravenously.

Heparins and Religious Considerations

The use of Lovenox and other heparins among Muslim patients is a sensitive topic because these medications are derived from porcine (pig) sources, which are considered haram (prohibited) in Islam. However, under the Islamic principle of “darurah” (necessity), their use is permitted if no halal-certified alternatives are available and the treatment is deemed life-saving.

Even so, some Muslims may choose not to receive such treatment, as patients have the right to make decisions for themselves based on their personal beliefs.

6. Fragmin

Fragmin syringe, substitute for Eliquis

Active ingredients: Dalteparin

Drug class: Low molecular weight heparin

Dosage form and strength: Single-dose prefilled syringes (2500 IU, 5000 IU, 7500 IU, 10000 IU, 12500 IU, 15000 IU, 18000 IU), single-dose vials (10000 IU), and multidose vials (25000 IU)

Dosage frequency: Once or twice daily injection, depending on the condition.

Approved indications:

    • Prevents heart complications in people with unstable chest pain (angina) or a mild type of heart attack (non-Q-wave myocardial infarction).
    • Prevents blood clots (DVT) after abdominal surgery, hip replacement, or in bedridden patients during severe illness.
    • Long-term treatment of blood clots (VTE) in adults with cancer to reduce the chance of recurrence, continuing for six months after the initial treatment.
    • Treats blood clots (VTE) in children (starting from birth, at least 35 weeks gestation) to prevent them from coming back.

Common side effects: Bleeding, temporary drop in the number of platelets, bruising and pain at the injection site, and temporary increase in liver enzymes.

PROS:

  • Approved to treat blood clots in cancer patients
  • Less expensive
  • Approved for use in pediatric patients for specific indications
  • Lower risk of non-major bleeding events in cancer-associated VTE

CONS:

  • Less convenient due to injections
  • May cause more side effects than Eliquis
  • Risk of injection site reactions
  • No specific reversal agent, partial reversal may be achieved with protamine sulfate

Eliquis offers a favorable efficacy and safety profile for reducing the risk of stroke and blood clots in patients with afib.

In cancer-associated VTE, Eliquis is now strongly recommended by the American Society of Clinical Oncology (ASCO) as a preventive measure for patients with cancer. However, Fragmin, which is considered the gold standard for cancer-associated VTE, has a lower risk of non-major bleeding compared to Eliquis, as observed in some studies.

In a meta-analysis, Fragmin showed a lower rate of clinically relevant non-major bleeding than Eliquis (5.9% vs. 8.7%). Similar results were found in another study, where Fragmin showed a 6% non-major bleeding rate compared to 9% for Eliquis.

Switching to or from Eliquis Alternatives

Here’s a guide to transitioning with Eliquis:

  • Switching from Warfarin to Eliquis: Stop warfarin and start Eliquis once your INR drops below 2.0.
  • From Eliquis to Warfarin: Eliquis can affect INR readings, so during the transition:
    1. Stop Eliquis and start both warfarin and a short-term injectable blood thinner at the time of your next Eliquis dose.
    2. Once your INR is at a safe level, stop the injectable and continue warfarin.
  • From Eliquis to other blood thinners: Discontinue Eliquis and begin the new anticoagulant (oral or injectable) at the time of your next scheduled Eliquis dose.
  • From Other Blood Thinners to Eliquis: Stop the current anticoagulant and start Eliquis at the time of the next scheduled dose of your previous medication.

Always check in with your healthcare provider for personalized advice.

Summary

Pradaxa, Savaysa, Xarelto, Warfarin, Lovenox, and Fragmin offer different approaches to anticoagulant therapy. Each medication has distinct characteristics, and working closely with your healthcare provider can help identify the most suitable choice for your condition. Taking the time to understand these options ensures a treatment plan that meets your needs.

Frequently Asked Questions

The most common blood thinners include anticoagulants such as warfarin (Coumadin), apixaban (Eliquis), and rivaroxaban (Xarelto), and antiplatelet drugs like aspirin and clopidogrel (Plavix). These medications work by preventing blood clots and reducing the risk of stroke or other complications.

Yes, a generic version of Eliquis (apixaban) has been approved by the FDA, but they are not yet available on the US market. In Canada, the generic version became available in 2022 and can be accessed through Canadian pharmacies. You can order this medication conveniently through online platforms like Pharma Giant, which partners with licensed Canadian pharmacies to serve US residents.

Anticoagulants, like warfarin and Eliquis, slow down the blood’s clotting process, while antiplatelets, such as aspirin and Plavix, prevent platelets from clumping together to form clots. Both are used to reduce clot risks but target different parts of the clotting process.

Yes, warfarin is commonly prescribed to prevent blood clots in individuals with atrial fibrillation. Regular blood tests (INR monitoring) are required to ensure its effectiveness and safety.

Although blood thinners significantly reduce the risk of clots, they do not completely eliminate the possibility. Factors like improper dosage, other health conditions, or missed doses can contribute to clot formation.

Thin blood is often caused by medications like anticoagulants, certain genetic conditions, or a lack of clotting factors in the blood. It can also result from conditions like hemophilia or liver disease.

Using Plavix and Eliquis together increases the risk of bleeding and is generally not recommended unless prescribed by a doctor under specific circumstances. Always consult a healthcare provider before combining these medications.

Plavix is an antiplatelet drug, while Xarelto is an anticoagulant. The choice between them depends on the condition being treated. Xarelto is often used for conditions like atrial fibrillation, while Plavix is preferred for preventing clots after certain heart or vascular procedures.

It’s best to consult your healthcare provider before consuming alcohol while taking Eliquis. Alcohol can increase the risk of bleeding, and even moderate consumption may not be advisable for everyone based on individual health factors. Prioritizing safety by avoiding alcohol is often recommended.

Plavix is not typically the first choice for atrial fibrillation but may be used in combination with aspirin in certain cases when anticoagulants are unsuitable. Always follow a doctor’s advice for treatment.

The safest blood thinner for atrial fibrillation varies by individual. Newer anticoagulants like Eliquis and Xarelto are often preferred due to fewer dietary restrictions and reduced need for monitoring compared to warfarin.

No, blood pressure medications primarily lower blood pressure and do not thin the blood. However, they are sometimes used alongside blood thinners in individuals with cardiovascular conditions.

Warfarin is an oral anticoagulant used for long-term prevention, while heparin is an injectable anticoagulant often used for short-term treatment in hospital settings. Both reduce clot formation but are administered differently.

Natural alternatives like turmeric, ginger, and garlic may have mild blood-thinning effects. But, no natural alternative can fully replicate Eliquis’ effectiveness. They are seen as supportive rather than as replacements and should always be used under medical supervision to avoid risks such as excessive bleeding or drug interactions.

Related Articles

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