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Plavix vs Eliquis
Introduction
For patients at risk of blood clots due to conditions such as atrial fibrillation or after certain types of heart surgery, anticoagulant or antiplatelet drugs can be life-saving. Plavix and Eliquis are two such medications that are often prescribed for these purposes. They each act on different pathways in the coagulation cascade but both aim to prevent clot formation in high-risk patients. Plavix, also known as clopidogrel, is an antiplatelet drug which prevents platelets from sticking together and forming a clot. On the other hand, Eliquis, whose generic name is apixaban, falls under the class of direct oral anticoagulants (DOACs) affecting Factor Xa in the blood-clotting process. Both have their own pros and cons related to efficacy, side effects profile and interactions with other drugs or food substances.
Plavix vs Eliquis Side By Side
| Attribute | Plavix | Eliquis |
|---|---|---|
| Brand Name | Plavix | Eliquis |
| Contraindications | Active pathological bleeding such as peptic ulcer or intracranial hemorrhage; should not be taken with thrombolytic agents or other anticoagulants unless advised by a doctor | Active pathological bleeding; should not be taken with thrombolytic agents or other anticoagulants unless advised by a doctor |
| Cost | Around $400 for 90 tablets of 75 mg; generic clopidogrel as low as $0.20/day to $1/day | Around $500 for 60 capsules of 5 mg; no generic equivalent available |
| Generic Name | Clopidogrel | Apixaban |
| Most Serious Side Effect | Excessive bleeding | Severe hemorrhaging |
| Severe Drug Interactions | Thrombolytic agents or other anticoagulants without doctor's advice | Thrombolytic agents or other anticoagulants without doctor's advice |
| Typical Dose | 75 mg/day; a one-time loading dose of 300 mg may be used under medical supervision | 5 mg taken orally twice a day; reduced to 2.5 mg twice daily for patients 80 years or older, weigh 60 kg or less, or have creatinine clearance ≤30 ml/min |
What is Plavix?
Clopidogrel (the generic name for Plavix) is an antiplatelet medication that was a significant development from the first generation of anticoagulant drugs. It reduces the risk of heart attack and stroke in people with cardiovascular disease by preventing platelets from clumping together, thereby thwarting blood clot formation. Clopidogrel was approved by the FDA in 1997, primarily for patients who had recently experienced a stroke or heart attack.
Comparatively, Apixaban (Eliquis) belongs to a newer class of anticoagulants known as direct oral anticoagulants (DOACs). Unlike Clopidogrel which works by inhibiting platelet aggregation, Eliquis prevents blood clots by directly inhibiting Factor Xa – an enzyme crucial to blood coagulation. This targeted approach results in Eliquis having fewer side effects than older medications like Plavix that affect multiple aspects of the clotting process. Both these medications are used in different clinical scenarios depending on individual patient's needs and medical history.
What conditions is Plavix approved to treat?
Plavix and Eliquis are both approved for the treatment of various conditions related to blood clots:
- Plavix (clopidogrel) is primarily used to prevent blood clots in people who have recently had a heart attack or stroke, as well as in individuals with certain disorders of the heartbeat.
- Eliquis (apixaban), on the other hand, not only helps prevent clotting after hip or knee replacement surgery but also prevents strokes and serious blood clots in people with atrial fibrillation that's not caused by a heart valve problem.
How does Plavix help with these illnesses?
Plavix is used to prevent blood clots by inhibiting the clumping of platelets in the blood. It achieves this by blocking a specific receptor (P2Y12 ADP receptor) on the surface of platelets. This receptor, when activated, stimulates platelets to aggregate and form blood clots. By blocking this receptor, Plavix prevents platelet aggregation, reducing the risk of clot formation. This is particularly useful for patients at risk of heart attacks or strokes, where blood clots can block the flow of blood to the heart or brain.
Eliquis, on the other hand, works by inhibiting a different part of the clotting process. It targets the enzyme Factor Xa, which plays a key role in the coagulation cascade, a series of chemical reactions that lead to the formation of a clot. By inhibiting Factor Xa, Eliquis slows the coagulation process, reducing the risk of clot formation. This makes it a valuable choice for preventing strokes in patients with atrial fibrillation and for treating and preventing deep vein thrombosis and pulmonary embolism.
What is Eliquis?
Eliquis is a brand name for apixaban, which is a direct factor Xa inhibitor; it decreases the clotting ability of the blood and thus reduces the risk of stroke and systemic embolism. Eliquis has been in the market since it was approved by the FDA in 2012. Unlike Plavix, which is an antiplatelet medication, Eliquis does not prevent the platelets in your blood from clotting. Instead, it targets a specific protein within the blood to help prevent clots from forming. This different way of functioning means that Eliquis has a side-effect profile that is also distinct from that of antiplatelet medications like Plavix. For instance, it does not cause as much bruising or bleeding as Plavix. Its efficacy in reducing the risk of stroke makes it a suitable choice for patients with nonvalvular atrial fibrillation, especially those who do not respond well to the typical antiplatelet medications such as Plavix.
What conditions is Eliquis approved to treat?
Eliquis is an FDA-approved medication that's used for the following:
- Reducing the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation, a common heart rhythm disorder.
- Treating deep vein thrombosis (DVT), a condition where blood clots form in veins deep within your body, typically the legs.
- Preventing DVTs and pulmonary embolisms (PE) after knee or hip replacement surgery. A PE is a sudden blockage in one of the lung arteries, usually due to a blood clot that traveled there from your leg.
- Treatment of PE and reducing future occurrences.
How does Eliquis help with these illnesses?
Eliquis, like Plavix, is a medication that contributes to the prevention of blood clot formation. It acts as an anticoagulant by inhibiting Factor Xa in the coagulation cascade, which plays a key role in blood clotting process. By doing so, Eliquis minimizes the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. Furthermore, it may reduce the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE), especially following hip or knee replacement surgery. Unlike Plavix which prevents platelets from clumping together to form clots, Eliquis directly interrupts the coagulation pathway at a critical point thereby offering more predictable anticoagulation response. Hence it might be favored over Plavix for certain conditions due to its novel mechanism.
How effective are both Plavix and Eliquis?
Both clopidogrel (Plavix) and apixaban (Eliquis) have established histories of success in reducing the risk of stroke and systemic embolism in patients with atrial fibrillation, and they were initially approved by the FDA about a decade apart. Since they act on different aspects of blood clotting pathways, they may be prescribed under different circumstances. The effectiveness of clopidogrel and apixaban was directly compared in a large-scale clinical trial named ARISTOTLE; Apixaban demonstrated superior efficacy to warfarin for preventing stroke or systemic embolic events.
A 2001 review of meta-analysis reports on Plavix showed that it is effective at reducing vascular death, myocardial infarction, or stroke when used long-term after an initial event. Its side effect profile is favorable over many other antiplatelets such as aspirin especially concerning gastrointestinal bleeding risks.
On the other hand, Eliquis has been shown to reduce mortality rates among those suffering from venous thromboembolism according to a 2013 review published in New England Journal Of Medicine. Furthermore, Eliquis might be considered preferable due to its lower rate of major bleeding as compared with warfarin. However, Eliquis might not be suitable for all patient groups especially those with severe renal impairment where dose adjustment would be required.
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At what dose is Plavix typically prescribed?
Oral dosages of Plavix typically start at 75 mg/day for the prevention of heart attack, stroke, and other vascular conditions. It's important to note that a one-time loading dose of 300 mg may be used in some circumstances under medical supervision. Alternatively, Eliquis is commonly prescribed at doses of 5 mg taken twice daily but can be reduced to 2.5mg twice a day depending on factors such as age or weight. As always with anticoagulant therapy, regular follow-ups are necessary to monitor response and adjust dosage if needed. The maximum recommended daily dose for either medication should not be exceeded unless directed by your healthcare provider.
At what dose is Eliquis typically prescribed?
Eliquis treatment is typically initiated at a dosage of 5 mg taken orally twice a day. For patients who are 80 years or older, weigh 60 kg or less, or have creatinine clearance levels at or below 30 ml/min, the dose should be decreased to 2.5 mg taken twice daily. There's no need to adjust the dosage based on gender. It's important that doses are spaced approximately twelve hours apart for optimal effectiveness and safety. In cases where there isn't adequate response after an initial period of administration (as judged by your healthcare professional), changes in dosing may be considered but maximum recommended total daily dose should not exceed 10mg divided into two doses.
What are the most common side effects for Plavix?
Common side effects of Plavix and Eliquis can include:
- Easy bruising or bleeding (nosebleeds, bleeding gums)
- Shortness of breath
- Headaches and dizziness
- Chest pain or pressure, especially if it radiates to the jaw, neck, or arm
- Nausea and upset stomach
- Diarrhea or constipation
- Fatigue and weakness
- Rashes
In more serious cases you may notice blood in your stools or heavy menstrual periods. If you experience any of these symptoms after taking either Plavix or Eliquis, seek immediate medical attention.
Are there any potential serious side effects for Plavix?
When comparing Plavix and Eliquis, it is important to note that both are anticoagulant drugs designed to prevent blood clots. However, each can potentially cause serious side effects in some individuals:
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Excessive bleeding: as with all anticoagulants, the most significant risk associated with both Eliquis and Plavix is excessive bleeding. This could manifest itself as frequent nosebleeds or gum bleeds, prolonged menstrual flow in women, red or black stools (indicating gastrointestinal bleed), pink or brown urine (signifying urinary tract bleed), unexplained bruising or hematoma formation.
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Allergic reactions: although rare, severe allergic reactions may occur while taking these medications. The symptoms include hives; swelling of the face, lips, tongue, or throat; difficulty breathing; chest tightness.
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Visual disturbances: blurred vision might be a sign of anemia caused by internal bleeding.
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Cardiovascular issues: rapid heart rate (tachycardia) and light-headedness might indicate substantial blood loss leading to decreased hemoglobin levels.
If you experience any of these symptoms with either medication—Plavix or Eliquis—it's crucial that you seek immediate medical attention.
What are the most common side effects for Eliquis?
Potential side effects related to Eliquis include:
- Easy bruising or minor bleeding (such as nosebleed, bleeding from cuts)
- Bleeding gums
- Nausea, decreased appetite
- Heavy menstrual flow
- Signs of serious bleeding include: bloody/black/tarry stools, pink/dark urine, coughing up blood or vomit that looks like coffee grounds.
- Unusual dizziness or tiredness may occur. In rare cases, individuals might experience a severe allergic reaction. Always contact your healthcare provider if you notice any unusual symptoms after starting this medication.
Are there any potential serious side effects for Eliquis?
While Eliquis is generally safe and effective, it's essential to be aware of potential adverse effects. These may include:
- Allergic reactions indicated by hives, itching, or a rash
- Difficulty breathing or swelling in your face or throat - immediate medical attention is required
- Unusual bleeding (nose, mouth, vagina, or rectum), bleeding from wounds or needle injections that doesn't stop
- Easy bruising; red, pinkish or brownish urine; black or bloody stools; spitting up blood/ coughing up blood
- Feeling dizzy/faint due to severe hemorrhaging
- Headache coupled with dizziness/severe weakness If you experience any of these symptoms while taking Eliquis , seek immediate medical help. Remember that this medication can cause serious and potentially fatal bleeding particularly if taken inappropriately. Always consult with a healthcare provider before starting on Eliquis.
Contraindications for Plavix and Eliquis?
Both Plavix and Eliquis, as with most other anticoagulant medications, may increase the risk of bleeding. If you notice prolonged bleeding from minor cuts or gums, increased bruising, bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds, please seek immediate medical attention.
Neither Plavix nor Eliquis should be taken if you are taking any drug regimen involving thrombolytic agents or other anticoagulants unless specifically advised by your doctor. Always inform your physician about all medications and supplements you are currently taking; some drugs require a washout period to clear from your system to prevent dangerous interactions with both Plavix and Eliquis.
Special caution is needed for those with active pathological bleeding such as peptic ulcer or intracranial hemorrhage. Both medications might need to be stopped before certain surgeries or dental procedures due to high risk of serious bleeding complications.
How much do Plavix and Eliquis cost?
For the brand name versions of these drugs:
- The price of 90 tablets of Plavix (75 mg) averages around $400, which works out to approximately $4.44/day.
- The price of 60 capsules Eliquis (5 mg) is roughly about $500, working out to around $8.33/day.
Thus, if you are taking a standard dose for either medication, then Plavix is less expensive on a per-day treatment basis than Eliquis. However, it's important to remember that cost should not be the main factor in choosing your medication – effectiveness and compatibility with your health conditions should be key considerations.
Moving onto generic versions:
- Clopidogrel (the generic form of Plavix) is available in packs ranging from 30 to 90 tablets with costs starting as low as $0.20/day up to around $1/day depending on the size pack you purchase upfront.
- Apixaban does not currently have a generic equivalent available in most places; hence its cost remains relatively high compared to clopidogrel.
Popularity of Plavix and Eliquis
Clopidogrel, as a generic drug and also under the brand name Plavix, was estimated to have been prescribed to about 20 million people in the US in 2020. Clopidogrel accounted for roughly 9% of anticoagulant prescriptions in the US. This medicine is well-established in its role for reducing heart attacks and strokes.
Apixaban, marketed under the brand name Eliquis, was prescribed to approximately 3 million individuals within America during that same period. In terms of all anticoagulants prescribed within the country, apixaban accounts for just around 8%. Over recent years there has been a steady rise in Apixaban usage due to its potential benefits over warfarin including fewer interactions with food or other drugs and no need for routine blood monitoring.
Conclusion
Both Plavix (clopidogrel) and Eliquis (apixaban) have a long history of use in preventing blood clots, with substantial clinical evidence supporting their efficacy over placebo treatments. These two drugs may be used together under the careful supervision of a physician; however, they can increase the risk of bleeding due to their combined anticoagulant effects. They work through different mechanisms: Plavix inhibits platelet aggregation while Eliquis works by directly inhibiting Factor Xa, an important part of the clotting cascade.
Plavix is often prescribed as a first-line treatment following heart attack or stroke, whereas Eliquis is generally used for patients with atrial fibrillation or after hip or knee replacement surgery. Both are available in generic form which provides significant cost savings especially for those paying out-of-pocket.
An adjustment period may be required when starting either medication, meaning that full protective effects might not be immediately evident.
The side effect profile is somewhat similar between these two medications - both can cause serious bleeding which should receive immediate medical attention. However, Eliquis has been associated with fewer major instances of hemorrhage compared to other anticoagulants like warfarin but more compared to antiplatelets such as clopidogrel. It's crucial that patients on either drug monitor for signs of unusual bruising or bleeding and seek medical help promptly if necessary.
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Refrences
- Chu, M. W. A., Wilson, S. R., Novick, R. J., Stitt, L. W., & Quantz, M. A. (2004, November). Does Clopidogrel Increase Blood Loss Following Coronary Artery Bypass Surgery?. The Annals of Thoracic Surgery. Elsevier BV.http://doi.org/10.1016/j.athoracsur.2004.03.028
- Avezum, A., Lopes, R. D., Schulte, P. J., Lanas, F., Gersh, B. J., Hanna, M., … Alexander, J. H. (2015, August 25). Apixaban in Comparison With Warfarin in Patients With Atrial Fibrillation and Valvular Heart Disease. Circulation. Ovid Technologies (Wolters Kluwer Health).http://doi.org/10.1161/circulationaha.114.014807
- Caldeira, D., Fernandes, R. M., Costa, J., David, C., Sampaio, C., & Ferreira, J. J. (2013, April). Branded Versus Generic Clopidogrel in Cardiovascular Diseases. Journal of Cardiovascular Pharmacology. Ovid Technologies (Wolters Kluwer Health).http://doi.org/10.1097/fjc.0b013e31827e5c60
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- Lyseng-Williamson, K. A., & Plosker, G. L. (2006). Clopidogrel. PharmacoEconomics. Springer Science and Business Media LLC.http://doi.org/10.2165/00019053-200624070-00009
- 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