Warfarin vs Eliquis
WarfarinEliquis
Vitamin K antagonistDrug ClassDirect oral anticoagulant (DOAC), Factor Xa inhibitor
Inhibits vitamin K-dependent clotting factors (II, VII, IX, X)Mechanism of ActionSelectively inhibits Factor Xa, reducing thrombin generation
- Atrial fibrillation (AFib) to reduce stroke risk - Deep vein thrombosis (DVT) - Pulmonary embolism (PE) - Mechanical heart valve replacement - Prevent recurrent clot formationIndications- Atrial fibrillation (non-valvular) to reduce stroke risk - DVT treatment and prevention - PE treatment and prevention - Postoperative DVT prevention (hip/knee replacement)
Tablets (1 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg, 10 mg)Dosage FormsTablets (2.5 mg, 5 mg)
Once daily (based on INR monitoring and adjustment)Dosing FrequencyTwice daily
Requires regular INR (International Normalized Ratio) monitoringMonitoring RequirementsNo routine monitoring required
Avoid foods high in vitamin K (e.g., spinach, kale)Dietary RestrictionsNo significant dietary restrictions
Numerous interactions with medications, supplements, and foodsDrug InteractionsFewer interactions compared to Warfarin
24-72 hours (delayed due to factor half-lives)Onset of Action3-4 hours
- Vitamin K (phytonadione) - Fresh frozen plasma (FFP) - Prothrombin complex concentrate (PCC)Reversal AgentsAndexanet alfa (specific reversal agent for Factor Xa inhibitors)
20-60 hours (varies based on genetic factors)Half-Life12 hours
Increased bleeding risk, especially with suboptimal INR controlBleeding RiskLower major bleeding risk compared to Warfarin
X (contraindicated in pregnancy due to teratogenicity)Pregnancy CategoryB (use with caution; consult physician)
Safe in renal impairment (adjust dose cautiously)Renal Function ConsiderationsRequires dose adjustment or avoidance in severe renal impairment
Avoid in significant hepatic disease due to impaired clotting factor productionHepatic Function ConsiderationsAvoid in severe hepatic impairment
Generally less expensive (generic widely available)CostHigher cost (brand-name only)
- Long track record and established efficacy - Generic availability lowers cost - Preferred in mechanical heart valvesAdvantages- No routine blood monitoring - Fewer drug/food interactions - Lower bleeding risk in specific populations
- Requires frequent INR checks - Many interactions - Diet restrictions - Delayed onset of actionDisadvantages- Expensive - Not suitable for mechanical heart valves - Requires strict dosing schedule
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