Eliquis vs. Coumadin

See how Eliquis and Coumadin compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Eliquis is a factor Xa inhibitor taken twice daily without routine blood testing, while Coumadin is a vitamin K antagonist that requires regular INR monitoring.

  • Coumadin is the only oral anticoagulant approved for patients with mechanical heart valves, an indication Eliquis does not have.

  • Eliquis costs significantly more out of pocket than Coumadin, which is available as a low-cost generic warfarin.

Eliquis vs. Coumadin Drug Summary

Eliquis

Eliquis (apixaban) is a factor Xa inhibitor used to prevent stroke in atrial fibrillation and to treat or prevent blood clots like DVT and PE. It's taken as a tablet twice daily and doesn't require routine blood monitoring.

Coumadin

Coumadin (warfarin) is a vitamin K antagonist used to prevent and treat blood clots, including in atrial fibrillation, DVT/PE, and mechanical heart valves. It's taken once daily but requires regular INR blood tests to keep dosing in a safe range.

Eliquis vs. Coumadin Side Effects

Eliquis

Most common
Epistaxis (up to 2.9%)
Contusion (up to 1.8%)
Hematuria (up to 1.7%)
Menorrhagia (up to 1.4%)

Coumadin

Most common
Hemorrhage (not specified as percentage on label)
Necrosis of skin/tissue (not specified as percentage on label)
Nausea (not specified as percentage on label)
Vomiting (not specified as percentage on label)

Eliquis vs. Coumadin Dosage

Eliquis

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 10 mg twice daily Days 1-7
Maximum dose 2.5 mg twice daily If needed
Dose changes 2 increases As tolerated

Coumadin

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 2 to 5 mg once daily Days 1-5
Maximum dose 2 to 10 mg once daily If needed
Dose changes 1 increase As tolerated

Eliquis vs. Coumadin Indications

Eliquis

Eliquis is FDA-approved to reduce the risk of stroke in people with nonvalvular atrial fibrillation and to treat or prevent DVT and PE. It's also used to prevent blood clots after hip or knee replacement surgery and to treat VTE in children.

  • Stroke prevention in nonvalvular atrial fibrillation

  • DVT prophylaxis after hip or knee replacement

  • Treatment of DVT and PE

  • Reducing risk of recurrent DVT and PE

Coumadin

Coumadin is FDA-approved to prevent and treat venous thrombosis and PE, and to reduce stroke risk in atrial fibrillation. It's also used to prevent clotting in people with mechanical heart valves and to reduce death or recurrent heart attack after an MI.

  • Venous thrombosis and PE treatment

  • Stroke prevention in atrial fibrillation

  • Clot prevention with mechanical heart valves

  • Reducing death and reinfarction after MI

Eliquis vs. Coumadin Pros and Cons

Eliquis

Eliquis works as a direct factor Xa inhibitor, so it doesn't require the routine blood testing that warfarin does. It's generally easier to dose consistently since it isn't affected by vitamin K in food, but it isn't an option for people with mechanical heart valves.

Pros

  • No routine blood monitoring needed

  • Fewer food and drug interactions than warfarin

  • Approved for pediatric VTE treatment

  • Specific reversal agent available for bleeding

Cons

  • Not approved for mechanical heart valves

  • Requires twice-daily dosing

  • Roughly $550 to $606 per month without insurance

Coumadin

Coumadin is a decades-old vitamin K antagonist that requires regular INR monitoring to keep dosing in a safe range. It costs much less out of pocket than Eliquis, but food and drug interactions make it harder to manage day to day. It remains the only oral anticoagulant approved for people with mechanical heart valves.

Pros

  • Approved for mechanical heart valve patients

  • Roughly $40 to $100 per month before insurance

  • Long-established safety record since 1954

  • Once-daily dosing

Cons

  • Requires regular INR blood monitoring

  • Significant interactions with food and drugs

  • Not safe during pregnancy

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