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Plavix vs Xarelto
Introduction
For patients with certain cardiovascular conditions such as atrial fibrillation or those who have recently undergone a heart surgery, certain anticoagulant drugs can help in reducing the risk of blood clots, strokes, and heart attacks. Plavix and Xarelto are two such medicines that are frequently prescribed for these conditions. They each impact different pathways of the blood clotting process, but both have effects in preventing clotting. Plavix, or clopidogrel, is an antiplatelet medication that works by inhibiting the platelets in the blood from clumping together to form a clot. Xarelto, on the other hand, is an anticoagulant drug, specifically a direct factor Xa inhibitor, which works by directly inhibiting the pathway of the blood clotting process, preventing the formation of fibrin, a protein that binds platelets together to form a clot.
Plavix vs Xarelto Side By Side
| Attribute | Plavix | Xarelto |
|---|---|---|
| Brand Name | Plavix | Xarelto |
| Contraindications | Should not be taken with certain drugs like NSAIDs, aspirin, or any other medication that affects blood clotting unless directed by a physician. | Should not be taken with certain drugs like NSAIDs, aspirin, or any other medication that affects blood clotting unless directed by a physician. |
| Cost | Around $300 for 30 tablets of 75 mg | Around $470 for 30 tablets of 20 mg |
| Generic Name | Clopidogrel | Rivaroxaban |
| Most Serious Side Effect | Unusual bleeding or bruises, signs of allergic reactions, blood in the urine or stools, severe headaches, chest pain, low red blood cell levels. | Unexpected bleeding, signs of an allergic reaction, sudden dizziness or loss of coordination, tingling sensation or muscle weakness, changes in vision, unusual changes in mood or behavior. |
| Severe Drug Interactions | Increased risk of severe bleeding when taken with other medications that affect blood clotting. | Increased risk of severe bleeding when taken with other medications that affect blood clotting. |
| Typical Dose | 75–300 mg/day, with 75 mg/day being sufficient for most people. | 15 mg twice daily with food for the first 21 days, then 20 mg once daily with an evening meal. |
What is Plavix?
Clopidogrel (the generic name for Plavix) is a commonly prescribed antiplatelet drug that was first approved by the FDA in 1997. It works by preventing blood platelets from clumping together to form a clot, thereby reducing the risk of heart attack and stroke. Plavix is often prescribed for individuals who have recently experienced a heart attack or stroke, or those with peripheral artery disease.
On the other hand, Rivaroxaban (the generic name for Xarelto) is a newer anticoagulant, approved by the FDA in 2011, that works by inhibiting a specific protein in the blood called Factor Xa to prevent blood clot formation. It is used to treat and prevent deep vein thrombosis and pulmonary embolism, and to reduce the risk of stroke in people with atrial fibrillation.
While both drugs are designed to prevent harmful clots, they work in different ways and have different side effect profiles. Plavix can cause excessive bleeding and bruising more than Xarelto, while Xarelto can lead to more gastrointestinal issues compared to Plavix. It's important to discuss these differences with your healthcare provider when deciding on the best treatment plan.
What conditions is Plavix approved to treat?
Plavix and Xarelto are both FDA-approved for the treatment of certain cardiovascular conditions:
- Acute coronary syndrome, including unstable angina and myocardial infarction (heart attack) in combination with aspirin, which is the case for Plavix.
- Reduction of risk of stroke in patients with nonvalvular atrial fibrillation and prevention or treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), as well as reduction in the risk of recurrence of DVT and PE after initial treatment. These are some uses for Xarelto.
How does Plavix help with these illnesses?
Plavix, or clopidogrel, helps to prevent blood clots by blocking platelets from sticking together and forming a clot. It does this by inhibiting the P2Y12 adenosine diphosphate (ADP) receptor on the surface of platelets, preventing ADP from activating it. Activation of the P2Y12 receptor is part of a series of reactions that result in platelets aggregating together and forming blood clots. Platelet aggregation plays an important role in hemostasis, wound healing, but also pathological processes like thrombosis. Therefore, by blocking ADP-induced activation of platelets, Plavix can limit the formation of harmful blood clots that could lead to conditions such as heart attack or stroke.
On the other hand Xarelto (Rivaroxaban) works differently - instead of affecting platelet function it directly affects one key component involved in coagulation cascade known as Factor Xa which leads to fibrin clot formation eventually when triggered due to certain signals. By selectively inhibiting Factor Xa , Rivaroxaban prevents clot formation stemming at very early stage unlike Clopidogrel which blocks downstream effectors leading to clot.
What is Xarelto?
Xarelto, also known by its generic name rivaroxaban, is an anticoagulant medication that works by inhibiting factor Xa, an enzyme necessary for blood clotting. This action reduces the blood's ability to form clots, which can be beneficial for preventing strokes and treating deep vein thrombosis and pulmonary embolism. Xarelto was first approved by the FDA in 2011. It does not require regular blood checks, which sets it apart from some other anticoagulants, including warfarin. Xarelto is taken orally once or twice daily, depending on the indication. Its side-effect profile is different from that of antiplatelet drugs such as Plavix. Specifically, it does not typically cause bleeding or bruising easily, but it can lead to other side effects like back pain, itching, or blistering. The action on factor Xa can be beneficial for patients with atrial fibrillation or those recovering from certain types of surgery, especially for those who cannot tolerate or have not responded well to other blood thinners like Plavix.
What conditions is Xarelto approved to treat?
Xarelto is approved for the treatment of a variety of conditions that require anticoagulation, or blood thinning. These include:
- Prevention and treatment of deep vein thrombosis (DVT) and pulmonary embolism
- Stroke prevention in individuals with non-valvular atrial fibrillation
- Reduction in risk after hip or knee replacement surgery to prevent DVT and pulmonary embolism.
It's important to note that Xarelto is an oral medication making it easier for patient compliance compared to other anticoagulants that require injection.
How does Xarelto help with these illnesses?
Xarelto, like Plavix, is a medication designed to prevent blood clots and strokes, particularly in individuals with certain cardiovascular or circulatory conditions. It works by selectively inhibiting certain clotting factors in the blood, therefore reducing the likelihood of clot formation. Xarelto's primary mechanism of action is on Factor Xa, a key enzyme in the coagulation cascade that leads to clot formation. This distinguishes it from Plavix, which acts to inhibit platelet aggregation by blocking a different pathway. The choice between the two often depends on a patient's unique medical history and needs. Because of its specific action on Factor Xa, Xarelto is often prescribed for patients with atrial fibrillation or those who are at high risk of deep vein thrombosis. It also does not require regular blood monitoring, which can make it a more convenient choice for some patients.
How effective are both Plavix and Xarelto?
Both clopidogrel (Plavix) and rivaroxaban (Xarelto) have well-established histories of success in preventing blood clots, with their FDA approvals coming just over a decade apart. They act by different mechanisms: clopidogrel is an antiplatelet drug that inhibits the formation of platelets, while rivaroxaban is an anticoagulant that functions as a direct inhibitor of factor Xa, an important component in the coagulation pathway.
The efficacy of both drugs was compared directly in several double-blind clinical trials. In 2006, Plavix showed similar efficacy to aspirin plus esomeprazole in preventing recurrent ulcer bleeding.[1] A 2012 study found no significant difference between Xarelto and warfarin for treating deep vein thrombosis without pulmonary embolism.[2]
[1] https://www.nejm.org/doi/full/10.1056/nejmoa061584 [2] https://www.nejm.org/doi/full/10.1056/NEJMoa1113572
A 2007 meta-analysis reported that clopidogrel combined with aspirin reduces major vascular events compared to aspirin alone among patients at high risk for such events.[3] The same meta-analysis also noted that clopidogrel has become one of the most widely prescribed medications worldwide due to its effectiveness.
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2222975/
A 2017 review suggested that rivaroxaban seems more effective than enoxaparin followed by vitamin K antagonist treatment for venous thromboembolism prevention after hip or knee replacement surgery,[4] but this superiority disappears when it's used long-term instead of short-term post-surgery.[5]
[4] http://dx.doi.org/10.1016/j.thromres.2017.03.022 [5 ]http://dx.doi.org//10.1136/bmjopen-2018-024600
Overall, both Plavix and Xarelto are effective options for reducing clot-related risks; however they are typically utilized under different circumstances given their distinct methods-of-action within the body.
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At what dose is Plavix typically prescribed?
Oral dosages of Plavix usually range from 75–300 mg/day, but studies have indicated that 75 mg/day is sufficient for preventing blood clots in most people. Children's dosage should be determined by a healthcare provider. In either population, dosage adjustments can be made based on individual response and tolerability. On the other hand, Xarelto is typically taken at 20 mg once daily with an evening meal for patients with nonvalvular atrial fibrillation and after hip or knee replacement surgery it's often taken as 10mg once daily. It must not exceed these recommended amounts unless under the direct guidance of a healthcare professional due to its potential increased risk of bleeding.
At what dose is Xarelto typically prescribed?
Xarelto treatment typically begins with a dosage of 15 mg taken orally twice daily with food, for the first 21 days. After this initial period, the dose is usually decreased to 20 mg once daily with an evening meal. This regimen helps prevent blood clots and stroke in patients with certain heart or blood vessel conditions. For preventing deep vein thrombosis (DVT) which may lead to pulmonary embolism (PE) following hip or knee replacement surgery, it is usually administered at a dose of 10mg once daily, taken at least two hours after food. The maximum recommended duration of administration is up to 35 days for hip replacement surgery and up to 12 days for knee replacement surgery based on patient response and tolerability.
What are the most common side effects for Plavix?
Common side effects of Plavix (clopidogrel) may include:
- Easy bruising and minor bleeding
- Diarrhea or constipation
- Pain in your stomach or indigestion
On the other hand, Xarelto (rivaroxaban) might lead to:
- Bleeding more easily
- Swelling or pain at the injection site
- Headache, dizziness, weakness, feeling like you might pass out
- Urine that looks red, pink, or brown; bloody or tarry stools; coughing up blood or vomit that looks like coffee grounds.
Please consult with a healthcare professional if any of these symptoms persist.
Are there any potential serious side effects for Plavix?
Although both Plavix and Xarelto are used to prevent blood clots, they can occasionally have serious side effects. In rare instances, these may include:
- Unusual bleeding or bruises that appear without clear cause
- Signs of allergic reactions such as hives, difficulty breathing, swelling in your face or throat
- Blood in the urine or stools
- Severe headaches; blurred vision; speech problems; weakness on one side of the body - these could be signs of a stroke
- Chest pain; sudden shortness of breath – these might indicate heart problems like angina pectoris or pulmonary embolism
- Low red blood cell levels leading to fatigue, pale skin color, shortness of breath with exertion
For those taking Xarelto specifically:
- Back pain associated with numbness or muscle weakness (in legs), and loss of bladder control could signal spinal cord injury due to bleeding following spinal anesthesia
If you experience any severe symptoms listed above while using Plavix or Xarelto it is crucial you seek medical attention immediately.
What are the most common side effects for Xarelto?
Potential side effects of Xarelto include:
- Bleeding gums and nosebleeds
- Unusual bruising or discoloration on your skin
- Blood in urine or stools, black tarry stools
- Coughing up blood or vomit that looks like coffee grounds
- Dizziness, fainting, feeling tired or weak
- Pain in wounds, longer healing times
- Headaches and potential confusion due to bleeding in the brain (rare)
- Difficulty breathing It's important to note when comparing Plavix with Xarelto that both medications can increase your risk of bleeding. It's essential to discuss these risks thoroughly with your healthcare provider before making a decision.
Are there any potential serious side effects for Xarelto?
Xarelto is often prescribed for the prevention of blood clots, but it can have some serious side effects that should be promptly reported to a healthcare provider. These may include:
- Signs of an allergic reaction or severe skin reaction: rashes, itching, difficulty breathing or swallowing, swelling in your face or throat
- Unexpected bleeding such as frequent nosebleeds, unusual bruising, coughing up blood, dark urine and stools
- Sudden dizziness or loss of coordination
- Tingling sensation or muscle weakness (especially in your legs)
- Changes in vision
- Unusual changes in mood or behavior including confusion and restlessness
Remember that Xarelto may cause more bleeding than usual due to its anticoagulant effect. If you notice any signs like these mentioned above while taking Xarelto, contact your doctor immediately.
Contraindications for Plavix and Xarelto?
Both Plavix and Xarelto, along with most other anticoagulant medications, may increase the risk of severe bleeding. If you notice unusual bleeding or bruising, blood in your urine or stools, persistent nosebleeds or any other signs of increased bleeding while on these medications, please seek immediate medical attention.
Neither Plavix nor Xarelto should be taken if you are taking certain drugs like nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin or any other medication that affects blood clotting unless directed by your physician due to potential interactions. Always inform your healthcare provider about all medications and supplements you are taking; some substances might need a period to clear from the system to prevent dangerous interactions with Plavix and Xarelto.
How much do Plavix and Xarelto cost?
For the brand name versions of these drugs:
- The price of 30 tablets of Plavix (75 mg) averages around $300, which works out to approximately $10/day.
- The price of 30 tablets of Xarelto (20 mg) averages about $470, working out to roughly $15.67/day.
Thus, if you are in the recommended dosage range for each medication (i.e., one tablet per day), then brand-name Plavix is less expensive on a per-day treatment basis than Xarelto. Please note that cost should not be a primary consideration in determining which of these blood thinners is right for you.
For the generic versions :
- Clopidogrel bisulfate (generic version of Plavix) costs significantly lower: For a pack size starting from 30 tablets up to larger quantities, prices may vary but approximate costs can be as low as $0.50 to over $2 per day depending on your dose and where it's purchased.
- As yet there isn't a widely available generic form for Rivaroxaban (Xarelto); therefore, its cost remains higher compared with clopidogrel.
Popularity of Plavix and Xarelto
Clopidogrel, in its generic form as well as the brand name Plavix, was estimated to have been prescribed to about 19 million people in the US in 2020. Clopidogrel accounted for a significant percentage of antiplatelet prescriptions - medications that prevent excessive blood clotting - making it an essential part of many patients' cardiovascular health plans.
Rivaroxaban, also known by its brand name Xarelto, had around 6.5 million prescriptions filled during the same year. It is a newer anticoagulant medication and it has been gaining popularity since entering the market due to its once-daily dosing and fewer dietary restrictions compared with other drugs used for similar indications. In fact, rivaroxaban's usage has consistently increased since first receiving FDA approval in 2011.
While both are prescribed for reducing risk of stroke and blood clots,the choice between clopidogrel and rivaroxaban may depend on individual patient factors such as kidney function or specific type of heart disease; thus discussing options with your healthcare provider is highly advised.
Conclusion
Both Plavix (clopidogrel) and Xarelto (rivaroxaban) have significant records of use in the prevention of blood clots, and they are supported by a wealth of clinical studies demonstrating their efficacy over placebo treatments. In some cases, these drugs may be used together under stringent medical supervision due to the increased risk for bleeding complications. Their differing mechanisms of action lead to different uses; Plavix works by blocking platelet aggregation while Xarelto inhibits Factor Xa in the coagulation cascade.
Plavix is often prescribed as first-line therapy after certain heart attacks or strokes, whereas Xarelto is typically favored for preventing blood clots following hip or knee replacement surgery, treating deep vein thrombosis and pulmonary embolism, and reducing stroke risk in patients with non-valvular atrial fibrillation.
Generic versions are available for both drugs which can result in cost savings especially for out-of-pocket payers. The effects of both Plavix and Xarelto may not be immediately noticeable but play an important role over time.
While both medications are generally well-tolerated, they carry similar risks associated with anticoagulant use like excessive bleeding. With either medication, patients should promptly seek medical attention if they experience unusual bruising or bleeding. As always when taking potent medications such as these it's crucial that you closely monitor any changes to your health status.
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Refrences
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- Cao, Y. B., Zhang, J. D., Shen, H., & Jiang, Y. Y. (2010, September 2). Rivaroxaban versus enoxaparin for thromboprophylaxis after total hip or knee arthroplasty: a meta-analysis of randomized controlled trials. European Journal of Clinical Pharmacology. Springer Science and Business Media LLC.http://doi.org/10.1007/s00228-010-0889-z
- Lyseng-Williamson, K. A., & Plosker, G. L. (2006). Clopidogrel. PharmacoEconomics. Springer Science and Business Media LLC.http://doi.org/10.2165/00019053-200624070-00009
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- Laux, V., Perzborn, E., Kubitza, D., & Misselwitz, F. (2007, July). Preclinical and Clinical Characteristics of Rivaroxaban: A Novel, Oral, Direct Factor Xa Inhibitor. Seminars in Thrombosis and Hemostasis. Georg Thieme Verlag KG.http://doi.org/10.1055/s-2007-982083
- Perzborn, E., Roehrig, S., Straub, A., Kubitza, D., Mueck, W., & Laux, V. (2010, March). Rivaroxaban: A New Oral Factor Xa Inhibitor. Arteriosclerosis, Thrombosis, and Vascular Biology. Ovid Technologies (Wolters Kluwer Health).http://doi.org/10.1161/atvbaha.110.202978
- Plosker, G. L. (2014, February 18). Rivaroxaban: A Review of Its Use in Acute Coronary Syndromes. Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40265-014-0188-6