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Warfarin vs Eliquis
Introduction
For patients with atrial fibrillation or those at risk of forming blood clots, certain anticoagulant drugs that inhibit the formation of clotting factors in the blood can be lifesaving by reducing risks of stroke and systemic embolism. Warfarin and Eliquis are two such drugs often prescribed for these conditions. They each impact different parts of the coagulation cascade but both have effects in preventing thrombus (clot) formation. Warfarin is a Vitamin K antagonist which prevents synthesis of vitamin K-dependent clotting factors II, VII, IX, and X. Eliquis, on the other hand, is an oral direct factor Xa inhibitor which inhibits platelet activation and fibrin clot formation within the blood vessels directly.
Warfarin vs Eliquis Side By Side
| Attribute | Coumadin | Eliquis |
|---|---|---|
| Brand Name | Coumadin | Eliquis |
| Contraindications | Uncontrolled or unusual bleeding, bruising easily, blood in urine or stool, severe headache or stomach pain; should not be taken with certain other medications that can increase the risk of bleeding complications such as antiplatelet drugs, NSAIDs, SSRIs, and SNRIs. | Uncontrolled or unusual bleeding, bruising easily, blood in urine or stool, severe headache or stomach pain; should not be taken with certain other medications that can increase the risk of bleeding complications such as antiplatelet drugs, NSAIDs, SSRIs, and SNRIs. |
| Cost | Approximately $0.83 per day for a 30-day supply of 5 mg | Approximately $16.60 per day for 60 tablets of 5 mg |
| Generic Name | Warfarin | Apixaban |
| Most Serious Side Effect | Unusual or prolonged bleeding, signs of an allergic reaction, unexpected bruising or blood in urine or stools, severe headache, dizziness, weakness, chest pain or discomfort, numbness on one side of your body, difficulty speaking and slurred speech, yellowing eyes/skin, dark urine. | Signs of severe allergic reaction such as hives, itching, a rash, or swelling particularly around the face and throat, difficulty breathing or swallowing, bruising more easily than usual or prolonged bleeding from cuts, blood in urine or stools, coughing up blood or vomit that looks like coffee grounds, severe headache, dizziness, weakness on one side of your body, slurred speech. |
| Severe Drug Interactions | Antiplatelet drugs (such as clopidogrel), nonsteroidal anti-inflammatory drugs (NSAIDs such as ibuprofen), serotonin reuptake inhibitors (SSRIs such as fluoxetine) and serotonin-norepinephrine reuptake inhibitors (SNRIs such as venlafaxine). | Antiplatelet drugs (such as clopidogrel), nonsteroidal anti-inflammatory drugs (NSAIDs such as ibuprofen), serotonin reuptake inhibitors (SSRIs such as fluoxetine) and serotonin-norepinephrine reuptake inhibitors (SNRIs such as venlafaxine). |
| Typical Dose | Oral dosages range widely, typically from 2–10 mg/day depending on the individual's response. | 5 mg taken orally twice daily. For certain patients, the dose may be reduced to 2.5 mg twice daily. |
What is Warfarin?
Warfarin (also known under the brand name Coumadin) was one of the first oral anticoagulants, marking a significant advancement from its predecessor drugs. Warfarin was approved by the FDA in 1954 and primarily works as a vitamin K antagonist to reduce blood clot formation. It is commonly prescribed for preventing heart attacks, strokes, and blood clots in veins and arteries. However, it requires regular monitoring with blood tests due to its narrow therapeutic index.
On the other hand, Apixaban (the generic name for Eliquis) is part of a newer class of anticoagulants known as direct factor Xa inhibitors. Approved by the FDA in 2012, Eliquis inhibits an enzyme involved in coagulation called factor Xa without requiring routine monitoring like warfarin does. Both medications are effective at reducing risk of stroke but unlike warfarin's interaction with food due to its mechanism on Vitamin K antagonism, apixaban has fewer dietary restrictions.
What conditions is Warfarin approved to treat?
Warfarin and Eliquis are both approved for the prevention or treatment of various medical conditions:
- Prevention of blood clots in patients with atrial fibrillation not caused by a heart valve problem
- Treatment, and secondary prophylaxis (prevention after initial occurrence) of venous thromboembolic events including deep vein thrombosis (DVT) and pulmonary embolism (PE)
- Prophylaxis of systemic embolism in patients with prosthetic heart valves.
How does Warfarin help with these illnesses?
Warfarin works to prevent blood clots by diminishing the production of certain proteins used in clotting. It does this by inhibiting vitamin K epoxide reductase, an enzyme necessary for recycling vitamin K in the body. Vitamin K is a key factor in producing these clotting proteins, so when Warfarin limits its availability, fewer clotting proteins are produced and thus the risk of forming harmful clots is reduced. Blood clots can cause serious conditions such as stroke or heart attack; therefore, by reducing their formation, Warfarin can help manage and prevent these potentially life-threatening issues.
On other hand Eliquis (apixaban), another anticoagulant drug like warfarin also prevents blood clots but through a different mechanism of action. Apixaban directly inhibits Factor Xa – a crucial protein involved in the coagulation cascade that leads to clot formation - thereby disrupting this process and decreasing the likelihood of dangerous thrombus development.
What is Eliquis?
Eliquis is a brand name for apixaban, an anticoagulant that prevents the formation of blood clots by inhibiting factor Xa, a protein vital in the coagulation process. It was first approved by the FDA in 2012. As Eliquis does not inhibit vitamin K (unlike warfarin), it has less interaction with food and other medications which can affect vitamin K levels in the body. This means its management requires less frequent blood monitoring compared to Warfarin. Its action on Factor Xa also results in a different side effect profile from Warfarin - specifically, it is associated with significantly lower rates of bleeding and mortality. The effects on Factor Xa make Eliquis particularly effective for stroke prevention in patients with nonvalvular atrial fibrillation and for preventing deep vein thrombosis (DVT) following hip or knee replacement surgery.
What conditions is Eliquis approved to treat?
Eliquis is an anticoagulant or blood thinner, that has been approved by the FDA for use in specific conditions:
- Prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation
- Treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), as well as to reduce the risk of recurrent DVT and PE following initial therapy.
How does Eliquis help with these illnesses?
Eliquis, also known as apixaban, operates on a similar principle to warfarin in that it is an anticoagulant, designed to prevent harmful clotting of the blood. However, Eliquis has a more targeted mechanism of action; it specifically inhibits factor Xa, an enzyme crucial for blood clot formation. This makes it effective in reducing the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. Unlike warfarin which requires regular monitoring due to variabilities among individuals regarding diet and drug interactions affecting its effectiveness, Eliquis does not necessitate such frequent checks making it more convenient for some patients. Hence Eliquis may be preferred over warfarin depending on patient lifestyle or response to Warfarin therapy.
How effective are both Warfarin and Eliquis?
Both warfarin and apixaban (Eliquis) have established histories of success in managing conditions that require anticoagulation, such as atrial fibrillation or deep vein thrombosis. Warfarin was first approved for use in the 1950s, while Eliquis received FDA approval more recently in 2012. The two drugs act on different parts of the coagulation pathway: warfarin inhibits vitamin K-dependent clotting factors, while apixaban directly inhibits Factor Xa.
A direct comparison between these two anticoagulants was conducted through a double-blind clinical trial known as ARISTOTLE in 2011; it demonstrated that patients taking Eliquis experienced fewer strokes or systemic embolism events compared to those on warfarin. Also noted were lower rates of major bleeding and mortality from any cause with Eliquis use.
Warfarin has been used extensively over many decades owing to its efficacy against thromboembolic diseases, but requires regular monitoring due to its narrow therapeutic window and numerous drug and food interactions which can affect patient response.
In contrast, a review published in 2016 presented evidence showing apixaban's effectiveness without the need for dose adjustments or routine blood tests for monitoring - making it easier to manage than warfarin. Patients using apixaban are also less likely to experience significant bleeding complications compared to those taking warfarin. Nonetheless, because each person responds differently to medication based on their unique physiology and genetics among other factors - some may fare better with one drug over another – so individual circumstances will dictate which is deemed more appropriate.
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At what dose is Warfarin typically prescribed?
Oral dosages of Warfarin range widely, typically from 2–10 mg/day depending on the individual's response to the drug. The dose is determined by regular blood tests and may need to be adjusted based on diet, other medications or changes in physical health. Children and adolescents' dosage needs are also determined through these same factors; it can vary greatly but should always be monitored very closely.
On the other hand, Eliquis (apixaban) usually has a standard adult dosage of 5mg taken orally twice a day for preventing stroke in those with nonvalvular atrial fibrillation. For patients aged 80 years or older, weighing less than or equal to 60 kg, or having serum creatinine levels greater than or equal to1.5 mg/dL: consider reducing the dose to 2.5 mg twice daily.
In either medication case, your healthcare provider will determine what dosage is most appropriate for you based on various factors including age, weight and kidney function among others.
At what dose is Eliquis typically prescribed?
Eliquis administration typically begins with a dosage of 5 mg taken orally twice daily. For patients over the age of 80, or those who have kidney disease, the recommended starting dose may be reduced to 2.5 mg twice daily. The maximum dose is generally 10 mg/day divided into two doses, spaced approximately 12 hours apart. It's crucial to continue taking Eliquis consistently as directed by your healthcare provider; if there's no noticeable improvement or reduction in stroke risk after a few weeks, they might consider adjusting your regimen accordingly. However, do not adjust your dosage without consulting with them first.
What are the most common side effects for Warfarin?
Common side effects of warfarin and Eliquis can include:
- Easy bruising or bleeding (nosebleeds, bleeding from gums)
- Bleeding from wounds that doesn't stop right away
- Coughing up blood
- Vomiting blood or material that looks like coffee grounds
- Headaches, feeling dizzy or weak
- Pain, swelling, or discomfort in the joints
- Rash
- Nausea If you experience any severe symptoms such as difficulty breathing or swallowing; swelling of the face, throat, tongue, lips; rash with peeling skin then seek immediate medical attention. These could be signs of serious allergic reactions.
Are there any potential serious side effects for Warfarin?
While considered safe for the majority of patients, Warfarin and Eliquis can cause side effects in rare cases. These may include:
- Unusual or prolonged bleeding
- Signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat
- Unexpected bruising or blood in urine or stools
- Severe headache, dizziness, weakness
- Chest pain or discomfort
- Numbness on one side of your body
- Difficulty speaking and slurred speech
Moreover: With Warfarin,
- Yellowing eyes/skin (signs of liver disease)
- Dark urine
With Eliquis,
- Pink/brown urine due to kidney problems.
If you experience any such symptoms while taking either medication, it’s crucial to seek immediate medical attention.
What are the most common side effects for Eliquis?
When taking Eliquis, some individuals may experience:
- Nausea and minor gastrointestinal issues
- Slight bleeding or bruising more easily
- Headache or dizziness
- Fatigue or feeling weak
- Rash or allergic reactions (although rare) It is important to note that while these side effects can occur, they are typically less frequent than with Warfarin. However, any unusual symptoms should be reported to your doctor immediately as they could potentially indicate a serious issue.
Are there any potential serious side effects for Eliquis?
Eliquis is generally considered safe but it's important to be aware of potential serious side effects. These can include:
- Signs of severe allergic reaction such as hives, itching, a rash, or swelling particularly around the face and throat.
- Difficulty breathing or swallowing due to an allergic reaction
- Bruising more easily than usual or prolonged bleeding from cuts
- Blood in urine or stools (which may look like tar)
- Coughing up blood or vomit that looks like coffee grounds
- Severe headache, dizziness, weakness on one side of your body
- Slurred speech which could indicate a stroke
If you experience any of these symptoms while taking Eliquis, seek immediate medical attention.
Contraindications for Warfarin and Eliquis?
Both Warfarin and Eliquis, like most anticoagulants, carry a risk of causing excessive bleeding. If you notice uncontrolled or unusual bleeding, bruising easily or more frequently than normal, blood in your urine or stool, severe headache or stomach pain; these could be signs of serious side effects and you should seek immediate medical attention.
Neither warfarin nor Eliquis should be taken if you are taking certain other medications that can increase the risk of bleeding complications. These include antiplatelet drugs (such as clopidogrel), nonsteroidal anti-inflammatory drugs (NSAIDs such as ibuprofen), serotonin reuptake inhibitors (SSRIs such as fluoxetine) and serotonin-norepinephrine reuptake inhibitors (SNRIs such as venlafaxine). Always tell your physician which medications you are taking to prevent dangerous interactions with Warfarin and Eliquis.
Unlike MAOIs used for treating depression which requires a period to clear from the system before starting on Wellbutrin or Prozac; switching between different anticoagulants like Warfarin to Eliquis does not usually require a washout period but it must be done under carefully monitored conditions by your healthcare provider.
How much do Warfarin and Eliquis cost?
For the brand name versions of these drugs:
- The price for 60 tablets of Eliquis (5 mg) averages around $500, which works out to $16.60 per day.
- Conversely, the price for a 30-day supply of Warfarin (5 mg) is about $25 in total, working out to approximately $0.83 per day.
Thus, if you're prescribed Eliquis at its standard dosage (10mg/day), it would be significantly more expensive than a typical course of Warfarin. However, cost should not be the primary factor when determining which drug is right for you as their uses and side effects differ greatly.
Moving on to generic versions:
- Generic warfarin costs even less—on average between about $4 and $20 for a month's supply depending on your dose—which can work out to as little as just over ten cents per day.
Remember that currently there isn't any approved generic version available in the market for Eliquis so it maintains its higher price point compared with Warfarin.
Popularity of Warfarin and Eliquis
Warfarin, both in generic form and under brand names such as Coumadin, was prescribed to approximately 8 million people in the USA in 2020. Warfarin has been the go-to anticoagulant for decades and accounted for nearly one-third of all prescriptions for blood thinners in the US. However, its use appears to be on a slow decline since newer alternatives have entered the market.
Apixaban, known better by its brand name Eliquis, was prescribed to about 6.1 million people in the USA during that same year. Apixaban constitutes around a quarter of all prescriptions for anticoagulants and has seen an increase in usage over recent years due to its lower risk of serious bleeding compared with warfarin. These two medications are often used interchangeably depending upon individual patient needs and physician recommendations; however, apixaban is gaining popularity due to fewer dietary restrictions and less need for regular blood tests compared with warfarin.
Conclusion
Both Warfarin and Eliquis (apixaban) have solid records of usage in preventing blood clots from forming or growing larger, particularly beneficial for patients with atrial fibrillation or those who have had knee or hip replacement surgery. They are both backed by extensive clinical studies indicating their effectiveness over placebo treatments. While both drugs work as anticoagulants, they do so through different mechanisms: warfarin inhibits the synthesis of vitamin K-dependent clotting factors, while Eliquis directly inhibits factor Xa.
Warfarin has been used for many years and is typically cheaper given its availability in generic form. Though it requires regular monitoring due to its narrow therapeutic window and interactions with food and other medications which can affect dosage requirements.
Eliquis is a newer drug that doesn't need regular monitoring like Warfarin does but tends to be more expensive even if cost savings might be achieved due to fewer necessary lab tests.
In terms of side effects, bleeding is common for both since they thin the blood; however, Eliquis has shown a lower risk of major bleeding events compared to warfarin. Patients using either medication should watch out for signs of abnormal bleeding and seek immediate medical attention if noted.
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Refrences
- 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
- 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
- Deeks, E. D. (2012, June). Apixaban. Drugs. Springer Science and Business Media LLC.http://doi.org/10.2165/11209020-000000000-00000
- Granger, C. B., Alexander, J. H., McMurray, J. J. V., Lopes, R. D., Hylek, E. M., Hanna, M., … Wallentin, L. (2011, September 15). Apixaban versus Warfarin in Patients with Atrial Fibrillation. New England Journal of Medicine. Massachusetts Medical Society.http://doi.org/10.1056/nejmoa1107039
- James, A. H., Britt, R. P., Raskino, C. L., & Thompson, S. G. (1992, August 1). Factors affecting the maintenance dose of warfarin. Journal of Clinical Pathology. BMJ.http://doi.org/10.1136/jcp.45.8.704