If you’re faced with a choice between blood thinners, you may be considering Eliquis and Warfarin. These anticoagulants are widely prescribed by cardiologists to prevent or treat blood clots and manage a range of medical conditions. But, how can you make the choice between the two?

In this article, we’ll explore the differences between Eliquis and Warfarin to help patients make the best choice for their ongoing health.

Eliquis: Explained

Eliquis (apixaban)Eliquis is the brand name for the drug apixaban, a prescription blood thinner. It’s taken orally to inhibit blood clotting, or coagulation.

How Does Eliquis Work?

Eliquis works as an anticoagulant by selectively blocking the effects of an enzyme known as factor Xa, or FXa. This is why your doctor may refer to Eliquis as a factor Xa inhibitor.

Your body needs FXa to develop the substances that trigger blood clotting. So, by affecting this enzyme, Eliquis reduces the risk of blood clotting, stroke, deep vein thrombosis, and pulmonary embolism.

Keep in mind that while Eliquis can lower your risk of getting a blood clot in the future, it won’t break up a blood clot that’s already developed.

What is Eliquis Used to Treat?

Eliquis is often used to treat atrial fibrillation, or AFib. It’s a type of heart arrhythmia that can lead to blood clots, heart failure, and stroke, among other heart complications. Eliquis reduces the risk of these potentially fatal complications in patients with AFib, and it’s the #1 oral blood thinner prescribed by cardiologists.

Along with AFib, Eliquis is used to treat:

  • Deep vein thrombosis and pulmonary embolism, often in patients undergoing knee or hip replacement surgery
  • Thrombocytopenia syndrome
  • Venous thromboembolism recurrence
  • A blood clot in the deep vein of an extremity
  • Blood clots caused by heparin-related low platelet levels

What Are The Side Effects of Eliquis?

Many patients are concerned about possible side effects before starting any new prescription medication, and Eliquis is no different. Some of the most common side effects of Eliquis include:

  • Bleeding for longer than usual from cuts and wounds
  • Gum and nose bleeding
  • Bruising more easily than usual
  • Dizziness
  • Headache
  • Nausea
  • Skin rash

Though the side effects listed above are common, let your physician know if you start to experience them while taking Eliquis. Additionally, if you’re taking Eliquis and experience blood in your urine or stool, or bleeding that won’t stop, go to the emergency room for immediate medical care.

Warfarin: Explained

WarfarinWarfarin is another oral anticoagulant that, like Eliquis, is prescribed to prevent blood clots. Warfarin was approved by the FDA in 1954 and, for several decades, was the only FDA-approved option to prevent stroke in atrial fibrillation patients. This all changed when the FDA approved three new anticoagulants in the early 2010s: Eliquis, Pradaxa, and Xarelto.

Given that AFib is the most prevalent type of irregular heartbeat, the wider range of available blood thinners for this condition was a welcome change. Nonetheless, Warfarin is a time-tested medication that’s still taken by millions of patients in the United States.

How Does Warfarin Work?

Warfarin reduces the risk of blood clots by inhibiting an enzyme known as vitamin K epoxide reductase complex 1, or VKORC1. This enzyme is necessary to activate the body’s available vitamin K, which in turn supports the production of blood coagulation factors in the liver.

Lower levels of vitamin K throughout your body lead to lower levels of coagulation factors. This makes it less likely that your blood will form clots, and that any existing clots will grow larger. However, just like Eliquis, Warfarin can’t disperse an existing blood clot.

What is Warfarin Used to Treat?

As we already mentioned, Warfarin is widely used to treat patients with atrial fibrillation. However, it may also be prescribed for:

  • Stroke
  • Heart attack
  • Pulmonary embolism
  • Deep vein thrombosis
  • Patients at a heightened risk for blood clots due to:
    • A prosthetic heart valve
    • Thrombophilia or other blood clotting disorders
    • Surgery

What Are The Side Effects of Warfarin?

The possible side effects of Warfarin include:

  • Bleeding that lasts longer than usual
  • Bleeding from the gums
  • Bleeding in between menstruation periods
  • Fever
  • Diarrhea
  • Vomiting
  • Loss of appetite
  • Stomach or abdominal pain

If any of the side effects listed above persist for several days or worsen, reach out to your physician right away. Additionally, be aware of more severe Warfarin side effects that may require emergency medical care, such as:

  • Severe bleeding, including abnormally heavy menstrual bleeding
  • Blood in urine or stool
  • Coughing or vomiting up blood, or a substance with a coffee ground-like appearance
  • Bruises that appear without cause or excessive bruising
  • Dizziness, lightheadedness, or weakness
  • Joint pain or swelling, particularly after an injury
  • Severe headache
  • Severe abdominal pain
  • Changes in vision
  • Skin sores, skin pain, or changes in skin color or temperature

How Are Eliquis and Warfarin Different?

Though Warfarin and Eliquis may be prescribed for the same conditions, including pulmonary embolism and deep vein thrombosis, they’re different in several key ways.

Mechanism

Simply put, Eliquis and Warfarin work differently. Eliquis blocks the enzyme FXa, while Warfarin blocks the enzyme that activates vitamin K. This means that Eliquis is classified as a Factor Xa inhibitor, while Warfarin is classified as a vitamin K antagonist.

Patient Monitoring

Warfarin and Eliquis require different degrees of patient monitoring. Patients taking Warfarin have to undergo regular blood testing to ensure that they’re taking the right dose. With too low of a dose, patients may be at risk for dangerous blood clots. But. with too high of a dose, patients are at risk for potentially fatal bleeding.

Patient monitoring for Warfarin involves weekly, biweekly, or monthly blood draws to test for prothrombin time and International Normalized Ratio (INR). The prothrombin time evaluates the amount of time needed for your blood to clot, while the INR concludes whether or not your blood thickness is within the normal range. For Warfarin patients, an INR between 2.0 and 3.0 is normal.

Eliquis, on the other hand, doesn’t require routine blood monitoring. This makes it a more convenient option for patients, as they won’t have to commute to monthly (or even weekly) appointments for lab work.

Risk of Severe Bleeding

Eliquis is less likely to cause severe bleeding than Warfarin. This is largely why Warfarin requires blood monitoring and Eliquis does not.

In one study, apixaban (the generic name for Eliquis) was associated with a reduced risk of major bleeding and gastrointestinal bleeding than Warfarin. Apixaban had a rate of less than 18 per 1,000 patients per year for major bleeding, compared to a rate of 29 per 1,000 patients per year for Warfarin. For gastrointestinal bleeding, Apixaban had a rate of 9 per 1,000 patients per year, compared to 12 per 1,000 patients per year for Warfarin.

Food Interactions

Patients taking Eliquis don’t have to worry about food interactions. Unfortunately, the same can’t be said for patients taking Warfarin.

Since Warfarin works by inhibiting the activation of vitamin K, patients need to be aware of foods that naturally contain vitamin K. Fluctuations in your vitamin K consumption could alter Warfarin’s effects.

If you consume high amounts of vitamin K in your diet, Warfarin might not work as well to prevent blood clots. Conversely, if you suddenly stop consuming your normal amount of vitamin K while taking Warfarin, the medication could excessively thin your blood.

Your physician can advise you on how to keep your vitamin K consumption consistent while you’re taking Warfarin. Note that patients generally aren’t advised to avoid dietary vitamin K, as it’s found in many foods that can benefit your health, like leafy green vegetables.

Action Time

Eliquis and Warfarin differ significantly in how fast they start to work. Eliquis works more rapidly, reaching peak levels within one to two hours of administration. It has a half-life of approximately 12 hours, meaning that it fully leaves the body within 24 hours.

Warfarin works at a much slower pace, reaching peak levels within 72 to 96 hours. Warfarin also takes significantly longer to leave the body, with a half-life of 20 to 60 hours.

Price

Considering that Eliquis doesn’t require blood monitoring, has a lower risk of severe bleeding, and works more rapidly, it’s often a hands-down choice over Warfarin to prevent blood clots. Sadly, despite these benefits, due to cost, Eliquis isn’t financially feasible for many patients.

The list price for a 2.5mg/30 tablets of Eliquis is $363, on average. Of course, insurance can cover much of this cost, but many patients lack the insurance coverage to make Eliquis affordable.

Without insurance, Warfarin costs approximately $22 for a 30 tablets. This is far less expensive than Eliquis, especially for patients paying out-of-pocket. Additionally, most insurance and Medicare plans will cover the cost of Warfarin in full.

Online pharmacies can make it easier for patients to afford the cost of their Eliquis prescription. But, before browsing online prescription discounts, make sure to talk to your physician about all of the treatment options available to you. At the end of the day, the priority is to select the safest, most effective treatment for your needs, whether it be Eliquis, Warfarin, or any of the other blood thinners on the market today.