Eliquis vs. Warfarin

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

Key Takeaways

  • Eliquis and warfarin both prevent dangerous blood clots, but Eliquis needs no routine blood testing while warfarin requires regular INR checks and dose adjustments.

  • Eliquis costs far more out of pocket than warfarin, which is one of the least expensive anticoagulants available.

  • Warfarin is the only oral anticoagulant approved for people with mechanical heart valves, a use Eliquis does not cover.

Eliquis vs. Warfarin Drug Summary

Eliquis

Eliquis (apixaban) is a Factor Xa inhibitor anticoagulant used to prevent stroke in atrial fibrillation, treat and prevent DVT and PE, and reduce clot risk after hip or knee replacement surgery. It's taken as a twice-daily tablet, with no routine blood testing required.

Warfarin

Warfarin (warfarin sodium) is a vitamin K antagonist anticoagulant used to treat and prevent DVT and PE, manage clot risk in atrial fibrillation or after valve replacement, and lower death or stroke risk after a heart attack. It's a once-daily tablet with doses adjusted by regular INR testing.

Eliquis vs. Warfarin 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%)

Warfarin

Most common
Calciphylaxis
Cholesterol emboli
Purple toes syndrome
Vasculitis

Eliquis vs. Warfarin 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

Warfarin

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 2 mg to 5 mg once daily Days 1-4
Maximum dose 2 mg to 10 mg once daily Day 5 onward
Dose changes 1 increase Every 4 days

Eliquis vs. Warfarin Indications

Eliquis

Eliquis is an anticoagulant approved to lower stroke risk in atrial fibrillation not caused by heart valve disease, prevent blood clots after hip or knee replacement surgery, and treat DVT and PE. It's also approved to reduce the risk of clots recurring after initial treatment, and is one of few anticoagulants approved for children.

  • Stroke prevention in nonvalvular atrial fibrillation

  • DVT prevention after hip or knee replacement surgery

  • Treatment of DVT and pulmonary embolism (PE)

  • Reducing risk of recurrent DVT and PE

Warfarin

Warfarin is a vitamin K antagonist approved to treat and prevent DVT and PE, prevent stroke and clotting complications in atrial fibrillation or after mechanical heart valve replacement, and lower the risk of death or a repeat heart attack after a myocardial infarction. It has been used for decades and is still the only oral anticoagulant approved for mechanical heart valve patients.

  • Treatment and prevention of DVT and PE

  • Stroke and clot prevention in atrial fibrillation

  • Clot prevention after mechanical heart valve replacement

  • Reducing death and stroke risk after a heart attack

Eliquis vs. Warfarin Pros and Cons

Eliquis

Eliquis offers predictable dosing without routine blood monitoring, making it more convenient for many patients, though it carries a boxed warning about stopping it early and a much higher price than warfarin. It's not an option for people with mechanical heart valves, who still need warfarin.

Pros

  • No routine blood test monitoring required, unlike warfarin's INR checks

  • Far fewer food and drug interactions than warfarin

  • Specific reversal agent available for bleeding emergencies

  • Approved for pediatric VTE treatment from birth

Cons

  • Taken twice daily, while some other newer anticoagulants are once daily

  • Not approved for patients with mechanical heart valves

  • Costs roughly $550 to $606 a month without insurance, far more than warfarin's $4 to $35

  • Lacks warfarin's decades-long real-world safety track record

Warfarin

Warfarin requires regular INR monitoring and careful attention to diet and drug interactions, but it remains the only oral anticoagulant proven for mechanical heart valve patients and costs a fraction of newer options. Its long track record and low cost keep it in wide use despite the extra monitoring burden.

Pros

  • Costs roughly $4 to $35 per month, far less than Eliquis

  • Only oral anticoagulant approved for mechanical heart valve patients

  • Effect can be quickly reversed with vitamin K if needed

  • Decades of clinical use and well-established safety data

Cons

  • Requires frequent blood testing (INR) and dose adjustments

  • Vitamin K intake, genetics, and many drugs can alter effectiveness

  • Carries added risks like skin necrosis and calciphylaxis

  • Slower onset often requires bridging with another anticoagulant

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