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Aspirin vs Eliquis
Introduction
For patients with blood clotting disorders or at risk of heart attack and stroke, certain medications that influence the coagulation process in the body can assist in preventing life-threatening events. Aspirin and Eliquis are two such drugs often prescribed for these conditions. They each affect different aspects of the blood clotting cascade but both have anticoagulant effects in patients. Aspirin is classified as a non-steroidal anti-inflammatory drug (NSAID), inhibiting platelet aggregation by preventing the production of thromboxane A2, a compound promoting platelets to clump together forming a clot. On the other hand, Eliquis is an oral direct factor Xa inhibitor which primarily affects one stage further down the coagulation pathway than aspirin does; it prevents prothrombin from turning into thrombin, an essential enzyme needed for fibrinogen to become fibrin - thus ultimately inhibiting formation of clots.
Aspirin vs Eliquis Side By Side
| Attribute | Aspirin | Eliquis |
|---|---|---|
| Brand Name | Aspirin | Eliquis |
| Contraindications | Known allergy to Aspirin or other NSAIDs | Taking certain antifungal medications such as ketoconazole and itraconazole |
| Cost | Around $7 for a bottle of 100 tablets (325 mg) | Approximately $450 for 60 capsules (5 mg) |
| Generic Name | Acetylsalicylic Acid | Apixaban |
| Most Serious Side Effect | Stomach upset/pain, heartburn, nausea, vomiting, difficulty hearing/ringing in the ears, severe allergic reactions, signs of bleeding like coughing up blood or vomit that looks like coffee grounds | Signs of an allergic reaction, unusual bruising or bleeding, heavy menstrual periods, pink/brown/red urine, black or bloody stools, coughing up blood, vomiting that resembles coffee grounds, sudden weakness on one side of the body, slurred speech, swelling in the face or tongue |
| Severe Drug Interactions | May require caution when switching from Warfarin to Aspirin due to different mechanisms affecting the clotting process | Contraindicated for those who are taking certain antifungal medications due to potential interaction increasing blood thinner effect |
| Typical Dose | 81–325 mg/day | 5 mg taken orally twice daily, reduced to 2.5 mg twice daily for patients 80 years or older, body weight of less than or equal to 60 kg, or serum creatinine levels greater than or equal to 1.5 mg/dL |
What is Aspirin?
Aspirin, also known as Acetylsalicylic Acid, is one of the oldest medications in use and was first synthesized by Felix Hoffmann at Bayer in 1897. As an antiplatelet drug, it prevents blood clots from forming by inhibiting platelets' ability to stick together. Therefore, it's often prescribed for heart attack prevention or after a stroke. On the other hand, Eliquis (generic name Apixaban) represents a new class of anticoagulants developed more recently with FDA approval granted in 2012. Instead of affecting the function of platelets like aspirin does, Eliquis directly targets clotting factor Xa to prevent blood clots from developing. This specific action makes Eliquis highly effective but also has fewer side effects compared to older anticoagulants that influence multiple clotting factors simultaneously.
What conditions is Aspirin approved to treat?
Aspirin and Eliquis are both approved for the treatment of various cardiovascular conditions:
- Aspirin is widely used to prevent heart attacks, strokes and blood clot formation in people at high risk for these conditions.
- Eliquis (generic name apixaban) is FDA-approved to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. It's also used post-surgery to prevent deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE), in patients undergoing hip or knee replacement surgery.
How does Aspirin help with these illnesses?
Aspirin helps to manage the risk of heart attacks and strokes by inhibiting the production of thromboxane, a substance that encourages blood clotting. It works by irreversibly blocking an enzyme known as cyclooxygenase (COX), which is involved in producing prostaglandins and thromboxanes from arachidonic acid. By reducing these substances, aspirin can lower the risk of clots forming and causing blockages in arteries or veins that could lead to serious cardiovascular events.
Eliquis, on the other hand, directly blocks Factor Xa, a key protein involved in your body's process of clot formation. This is different from aspirin's mechanism - instead of affecting platelet function like Aspirin does, Eliquis reduces the ability for blood clots to form through its action on this specific part of the coagulation cascade. These differences highlight why they may be used together or separately depending on individual patient circumstances such as their general health condition or presence of certain disease states.
What is Eliquis?
Eliquis, also known as apixaban, is an anticoagulant medication that operates by inhibiting the action of Factor Xa, an enzyme necessary for blood clotting. It was first approved by the FDA in 2012. Apixaban does not affect platelet aggregation and thus differs from aspirin, which functions to inhibit platelets from clumping together to form a clot. The distinctive mechanism of Eliquis means its side-effect profile is different than that of aspirin; it's less likely to cause gastrointestinal bleeding and ulcers (common adverse effects with long-term use of Aspirin). However, it can increase the risk of easy bruising or prolonged bleeding events – this effect on coagulation can be beneficial for reducing stroke risk in patients with atrial fibrillation or preventing deep vein thrombosis following hip or knee replacement surgery.
What conditions is Eliquis approved to treat?
Eliquis (apixaban) is approved for several key uses:
- The prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation
- Prophylaxis of deep vein thrombosis (DVT), which may lead to pulmonary embolism, in patients who have undergone hip or knee replacement surgery
- Treatment of DVT and pulmonary embolism
- To reduce the risk of recurrent DVT and pulmonary embolism after initial therapy.
How does Eliquis help with these illnesses?
Eliquis, like aspirin, plays a crucial role in preventing clot formation; however, it functions differently. Eliquis works by inhibiting Factor Xa - an enzyme necessary for the blood to form clots. By doing so, it promotes smoother circulation and reduces the risk of stroke or severe cardiovascular events in patients with certain heart conditions or those who have undergone hip or knee replacement surgery. This makes Eliquis particularly beneficial for individuals at high risk of these complications. As compared to aspirin which blocks thromboxane production, thus reducing platelet aggregation and subsequent clotting, Eliquis provides a targeted approach by directly acting on coagulation cascade. Therefore, when a patient's condition calls for more than just antiplatelet action (like that provided by aspirin), or if they are intolerant to aspirin's gastrointestinal side effects, anticoagulants like Eliquis might be prescribed either as an alternative or in combination with other medications.
How effective are both Aspirin and Eliquis?
Both aspirin and apixaban (Eliquis) have shown effectiveness in preventing blood clots, though they were approved by the FDA several decades apart. Due to their different mechanisms of action, these drugs may be prescribed under distinct circumstances. Aspirin works by inhibiting the production of thromboxane, a substance that makes platelets sticky and promotes clotting, whereas apixaban is an anticoagulant that prevents blood from clotting by directly inhibiting factor Xa.
In 2012, a major clinical trial compared aspirin with apixaban for stroke prevention in atrial fibrillation patients; this study revealed slightly superior efficacy of apixaban but also demonstrated similar safety profiles between the two drugs. In terms of side effects, both carry a risk for bleeding complications; however, while gastrointestinal bleedings are more commonly associated with aspirin use due to its gastric irritant properties, Eliquis carries an increased risk for serious internal bleeding events including cerebral hemorrhage.
A review conducted in 2009 highlighted aspirin's long history of usage as well as its broad range of applications beyond anti-clotting such as pain relief and reduction in heart attack or stroke risks. Despite being widely available over-the-counter at low cost and having been used since ancient times for its analgesic properties derived from willow bark extract salicylate compound precursors', it should not be underestimated - overdosing can lead to serious health problems like liver damage or even death.
On the other hand, recent reviews suggest that despite being one among many newer anticoagulants on market today (direct oral anticoagulants/DOACs), Eliquis seems to offer advantages over some competitors when it comes to balance between efficacy vs safety profile - i.e., how well drug works versus what kind/scale potential harms might ensue if things go wrong during treatment course given individual patient characteristics & conditions etc.
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At what dose is Aspirin typically prescribed?
Oral dosages of Aspirin range from 81–325 mg/day for heart-related uses, but studies have indicated that a daily dose of 81 mg (baby aspirin) is adequate for most people in preventing heart attack and stroke. Eliquis, on the other hand, is typically prescribed at doses of 2.5 or 5 mg twice daily depending upon individual factors such as age, kidney function and body weight. For either medication, dosage can be modified based on patient response and tolerability under a healthcare provider's guidance. However, exceeding the recommended dosage can lead to increased risk of bleeding complications.
At what dose is Eliquis typically prescribed?
Eliquis treatment is generally initiated at 5 mg taken orally twice daily. For patients who are 80 years or older, have a body weight of less than or equal to 60 kg, or those with serum creatinine levels greater than or equal to 1.5 mg/dL, the recommended dosage is reduced to 2.5 mg twice daily. This dose can be maintained unless there are significant changes in kidney function which necessitates adjustment by your healthcare provider. It's imperative that doses of Eliquis are taken approximately12 hours apart and not exceeded as it may increase the risk of bleeding complications.
What are the most common side effects for Aspirin?
Common side effects of Aspirin and Eliquis can include:
- Upset stomach, heartburn or nausea
- Increased risk of bleeding
- Dizziness or lightheadedness
- Bruising more easily
- Diarrhea
- Skin rash or itching
- Abdominal pain (Aspirin)
- Minor bleeding such as nosebleeds, bleeding gums (Eliquis)
It's important that you contact your healthcare provider if you experience any unusual symptoms while taking these medications. These could be signs of a serious reaction to the medication.
Are there any potential serious side effects for Aspirin?
Eliquis and Aspirin are both used to prevent blood clots, but they can have different side effects. In rare cases, serious side effects from Eliquis may include:
- Signs of bleeding such as persistent or severe headache; dizziness or fainting; unusual or prolonged bruising/bleeding (e.g., frequent nosebleeds, unexplained bruising, black stools); bloody/cloudy urine
- Yellowing eyes/skin
- Severe nausea/vomiting
- Shortness of breath
- Sudden vision changes
As for Aspirin, be mindful that it can occasionally cause:
- Stomach upset/pain
- Heartburn
-Nausea
- Vomiting
- Difficulty hearing/ringing in the ears
In extreme cases with either drug:
- If you notice any signs of a severe allergic reaction such as rash; itching/swelling (especially of the face/tongue/throat); severe dizziness; trouble breathing,
- Any symptoms suggestive of bleeding like coughing up blood, vomit that looks like coffee grounds,
you should seek immediate medical attention.
What are the most common side effects for Eliquis?
When compared to Aspirin, Eliquis has a different range of potential side effects. Notable ones include:
- Bleeding more easily or heavier than normal, including from the gums or nose.
- Increased bruising.
- Dizziness or weakness due to blood loss.
- Blood in urine or stools (either red, brown, or black colored).
- Unusual pain and swelling after injury.
Remember that these symptoms can be signs of serious internal bleeding. Although less common, there might also be nausea and minor skin rash. It's important to note that while both Aspirin and Eliquis are used for preventing blood clots they work in different ways and should not be interchanged without consulting with your healthcare provider.
Are there any potential serious side effects for Eliquis?
Eliquis is generally well-tolerated, but it may cause severe side effects in rare cases. These include:
- Signs of an allergic reaction: itching, hives, skin rash with redness or blistering and peeling
- Difficulty breathing or swallowing due to throat swelling
- Unusual bruising or bleeding (nosebleeds, bleeding gums), heavy menstrual periods
- Pink, brown or red urine; black or bloody stools; coughing up blood; vomiting that resembles coffee grounds
- Sudden weakness on one side of the body, slurred speech
- Swelling in the face or tongue.
In case you notice any of these symptoms while taking Eliquis , stop using it immediately and seek medical attention.
Contraindications for Aspirin and Eliquis?
Both aspirin and Eliquis, as with any anticoagulant or antiplatelet drugs, can increase your risk of bleeding. If you notice notable bruising or prolonged bleeding after minor cuts, please seek immediate medical attention.
Aspirin should not be taken if you have a known allergy to it or other NSAIDs. Also, Eliquis is contraindicated for those who are taking certain antifungal medications such as ketoconazole and itraconazole due to their potential interaction that may lead to increased blood thinner effect.
Always inform your physician which medications you are currently taking; some may require a period of clearance from the system before starting on aspirin or Eliquis in order to prevent dangerous interactions. For example, there is a need for caution when switching from Warfarin (another kind of blood thinner) to either Aspirin or Eliquis because they all affect the clotting process but through different mechanisms.
How much do Aspirin and Eliquis cost?
For the brand name versions of these drugs:
- The price for a bottle containing 100 tablets of Aspirin (325 mg) averages around $7, which works out to about $0.07 per day if you are taking one tablet daily.
- The price of 60 capsules of Eliquis (5 mg) is approximately $450, working out to roughly $15/day.
Thus, if you are on a standard dosage for Eliquis (i.e., 5mg twice daily), then branded aspirin is significantly less expensive on a per-day treatment basis. However, cost should not be your primary consideration in determining which drug is suitable for you as they have different mechanisms and indications.
As for generic versions:
- A pack of generic aspirin with the same dosage can be obtained at an even lower cost ($3-$4 per bottle), reducing your expense further.
- Apixaban - the active ingredient in Eliquis – does not yet have a generic version available due to patent laws; hence its costs remain high until such time as competitors are allowed into the market.
Popularity of Aspirin and Eliquis
Aspirin, in generic form as well as brand names such as Bayer and St. Joseph, was estimated to have been used by about 29 million people in the US aged 40 and above in 2019. Aspirin accounted for a significant portion of over-the-counter pain reliever usage in the US, especially among those using it for its cardio-protective properties. The prevalence of aspirin has been generally stable over recent years.
Apixaban, commonly known under the brand name Eliquis, is an anticoagulant that prevents blood clots in patients with atrial fibrillation or who have recently had knee or hip replacement surgery. It was prescribed to approximately 5.9 million people in the USA in 2020. In terms of overall anticoagulant prescriptions within this demographic, apixaban accounts for just around 34%. Its use has been on a steady increase since it received FDA approval back in late 2012.
Conclusion
Both aspirin and Eliquis (apixaban) are widely used anticoagulant drugs that help to prevent blood clots, with extensive clinical data supporting their effectiveness. They may be utilized together in certain cases, but this requires careful evaluation by a physician due to the increased risk of bleeding. Their differing mechanisms of action mean they are typically prescribed under different circumstances: aspirin works by inhibiting platelet aggregation while Eliquis is a direct inhibitor of Factor Xa, an enzyme crucial for blood clot formation.
Aspirin is considered a first-line treatment for preventing heart attacks and strokes in individuals at high risk, whereas Eliquis would usually be recommended as part of therapy for atrial fibrillation or after hip or knee replacement surgery.
Both medications are available as generics which can result in cost savings especially when paying out-of-pocket; however, it should be noted that Eliquis tends to be more expensive than Aspirin.
The side effect profiles between these two medications differ slightly - both can increase the risk of bleeding complications but gastrointestinal side effects such as stomach upset and ulcers tend to occur more with aspirin use. For both drugs, patients must keep track of any unusual bruising or bleeding and seek immediate medical attention if these occur.
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Refrences
- Agrawal, R., Jain, P., & N. Dikshit, S. (2012, May 1). Apixaban: A New Player in the Anticoagulant Class. Current Drug Targets. Bentham Science Publishers Ltd.http://doi.org/10.2174/138945012800564059
- Keating, G. M. (2013, May 16). Apixaban: A Review of its Use for Reducing the Risk of Stroke and Systemic Embolism in Patients with Nonvalvular Atrial Fibrillation. Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40265-013-0063-x
- Aryal, M. R., Pandit, A., Ghimire, S., Pathak, R., Karmacharya, P., Ram Poudel, D., & Shamoun, F. E. (2015, January). Thromboprophylaxis with apixaban and the risk of pulmonary embolism in patients undergoing knee replacement surgery. Journal of Community Hospital Internal Medicine Perspectives. Greater Baltimore Medical Center.http://doi.org/10.3402/jchimp.v5.27889
- Leys, D., Balucani, C., & Cordonnier, C. (2009). Antiplatelet Drugs for Ischemic Stroke Prevention. Cerebrovascular Diseases. S. Karger AG.http://doi.org/10.1159/000200449
- Watson, J., Whiteside, G., & Perry, C. (2011, October). Apixaban. Drugs. Springer Science and Business Media LLC.http://doi.org/10.2165/11596820-000000000-00000