Plavix vs Eliquis

Blood clots are thick, gel-like masses formed by clumped blood. This process, called coagulation, is a normal response to injury that helps prevent excessive bleeding when a cut or injury occurs. However, blood clots can also develop inside blood vessels without an obvious injury.

When this occurs, the clot can obstruct blood flow to critical organs like the heart, lungs, or brain, posing a serious threat. These types of clots are especially dangerous, leading to potentially life-threatening conditions. Alarmingly, blood clots are responsible for the deaths of an estimated 274 people each day.

Fortunately, several blood thinners are available to help prevent unwanted blood clots. Two common choices are Plavix (clopidogrel) and Eliquis (apixaban). This article will examine how each drug works, its benefits and risks, and what the latest research says.

Plavix vs Eliquis Bleeding Risk

The most common side effect of Eliquis and Plavix is bleeding. It can occur in various parts of the body, including the gastrointestinal tract and brain (intracranial hemorrhage). Other common bleeding events include nosebleeds, blood in urine, and bruising.

However, the types of bleeding observed with Eliquis include rectal hemorrhage and bleeding in other organs, such as the eyes and skin. Additionally, Eliquis can cause heavy menstrual bleeding and post-operative bleeding, including wound hemorrhage and bleeding at the incision site.

Eliquis vs Plavix Mechanism of Action

Plavix and Eliquis work through distinct mechanisms to prevent blood clots.

How Does Plavix Work?

Plavix is a P2Y12 inhibitor from the thienopyridine class of antiplatelet drugs. It irreversibly blocks the P2Y12 receptor on platelets (tiny blood cells involved in clotting), preventing them from clumping together to form clots. However, Plavix is a prodrug medication. It starts off inactive and needs to be activated by certain liver enzymes, including CYP2C19 and CYP3A4, once inside the body.

This activation happens in two steps. However, some people have genetic variations that affect these enzymes, meaning their bodies might not activate Plavix properly. This can make the medication less effective or even ineffective in some people.

How Does Eliquis Work?

Eliquis prevents blood clots by blocking a protein called factor Xa, which is crucial for clot formation. By inhibiting factor Xa, Eliquis also reduces the production of thrombin, another essential protein for forming blood clots.

One advantage of Eliquis is its high selectivity for factor Xa, which is 30,000 times more selective for this protein than for similar proteins involved in blood clotting. This results in minimal impact on other proteins and processes in the body.

Approved Indications for Plavix and Eliquis

Plavix and Eliquis do not have the same indications, although they are both used to reduce the risk of blood clots.

FDA-Approved Indications for Plavix:

1. Acute Coronary Syndrome (ACS): Plavix is indicated for the reduction of atherothrombotic events (myocardial infarction, stroke, and vascular death) in patients with:

• • Unstable Angina (UA) or Non-ST-Segment Elevation Myocardial Infarction (NSTEMI)
  • ST-Segment Elevation Myocardial Infarction (STEMI)

2. Lower the risk of heart attack, stroke, and vascular death in patients with a history of recent myocardial infarction, recent ischemic stroke, or established Peripheral Arterial Disease (PAD).

FDA-Approved Indications for Eliquis:

1. Reduction of risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (NVAF)
2. Reduce the risk of deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE) in patients who have undergone hip or knee replacement surgery
3. Treatment of DVT and PE
4. Reduce the risk of recurrent DVT and PE following initial therapy

Reversal Agents of Eliquis and Plavix

Reversal agents are medications used to counteract the effects of anticoagulants, effectively reversing their blood-thinning properties.

Reversal Agents for Eliquis

Andexanet alfa (Andexxa®) is the reversal agent for Eliquis and other factor Xa inhibitors. The ANNEXA-A and ANNEXA-R trials showed that Andexanet alfa reverses the anticoagulant activity of apixaban within minutes, maintaining this effect during infusion without clinical toxicity.

The most common side effects of Andexxa were urinary tract infections,  pneumonia, and infusion-related reactions.

Reversal Agents for Plavix

Plavix does not have a reversal agent. If a patient on Plavix needs urgent reversal due to bleeding or before surgery, the options are generally limited to stopping the medication and supporting the patient with blood products or platelet transfusions.

Some clinicians may consider using platelet transfusions in cases of life-threatening bleeding. However, these methods are not direct reversal agents but supportive measures to manage the bleeding risk.

Plavix vs Eliquis Cost

Both Eliquis and Plavix are brand-name medications. The list price for a 30-day supply of Eliquis is $594, with an average retail price of $727.96. Plavix is less costly than Eliquis, averaging $255 at retail.

The FDA has approved generic versions of both Eliquis and Plavix. However, generic Eliquis won’t be available in the US for several more years due to a patent extension by Bristol Myers Squibb and Pfizer, the original makers of the drug. Initially set to expire in February 2023, the patent has been extended until November 2026.

Fortunately, Canadian pharmaceutical manufacturer Apotex Inc. has launched the first generic alternative to Eliquis in Canada. As a result, the cheapest place to buy Eliquis and Plavix, including their generic versions, is from online Canadian pharmacy partners.

For example, Eliquis is available for just $157 at Pharma Giant, with the generic version starting at $90. Plavix is available for as low as $70, and its generic counterpart starts at just $35.

Can You Take Plavix and Eliquis Together?

Taking Plavix and Eliquis together is generally not recommended unless specifically advised by a healthcare provider. Both medications are used to reduce the risk of blood clots but work through different mechanisms—Plavix is an antiplatelet agent, while Eliquis is an anticoagulant.

Using them together increases the risk of severe bleeding, including gastrointestinal bleeding or hemorrhagic stroke. However, a healthcare provider may prescribe both in certain high-risk situations, carefully balancing the benefits of preventing clots with the increased risk of bleeding.

Which is Better: Plavix vs Eliquis

Plavix and Eliquis are blood thinners that function in distinct ways and are approved for different medical conditions. Although it’s rare, there are occasions when both Plavix and Eliquis might be prescribed together. However, it’s generally advisable to avoid using Plavix or Eliquis alongside other blood thinners or non-steroidal anti-inflammatory drugs (NSAIDs) unless directed by your healthcare provider.

Frequently Asked Questions