Eliquis and warfarin are both blood thinners, or anticoagulants, used to prevent and treat blood clotting disorders
Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ
Eliquis and warfarin are medications used in the prevention and treatment of clotting disorders. Both drugs are oral anticoagulants. By preventing blood clots, anticoagulants lower the risk of stroke, deep vein thrombosis, and other clotting disorders. Blood thinners like Eliquis and warfarin are usually prescribed by a cardiologist.
Eliquis is classified in a group of medications called factor Xa inhibitors. Eliquis works by blocking factor Xa, which produces thrombin. Thrombin helps clot production. By blocking factor Xa, Eliquis decreases the production of blood clots. Eliquis is a novel oral anticoagulant (NOAC), which is a group of newer blood thinners, also known as direct oral anticoagulants (DOAC).
Warfarin is classified as a vitamin K antagonist. It works by inhibiting the release of plasma clotting factors by vitamin K.
Although both Eliquis and warfarin are known as blood thinners, or anticoagulants, they are not the same. Continue reading to learn more about Eliquis and warfarin.
Eliquis (Apixaban) and warfarin (generic Coumadin) are both anticoagulants, or blood thinners. Both drugs are approved by the U.S. Food and Drug Administration (FDA) for prescription use.
Eliquis is made by Bristol-Myers Squibb. Eliquis is available in brand name only, but a generic will likely be available soon.
Warfarin is available in generic only. The brand-name product, Coumadin, was discontinued by its manufacturer in April 2020. Warfarin is made by a variety of manufacturers.
Warfarin requires routine monitoring of the international normalized ratio (INR) through blood tests, while Eliquis does not require regular INR monitoring.
The INR measures how quickly the blood clots. If the blood clots too quickly, there is a higher risk for blood clots. If the blood is clotting too slow, there is more of a risk for bleeding. The goal is to keep the INR in a therapeutic range (usually 2 to 3, but may vary based on the person), where the blood does not clot too fast or too slow. Based on the INR blood test results, the warfarin dose may be changed.
Eliquis vs. Warfarin
Eliquis WarfarinDrug class
Factor Xa
inhibitor
Vitamin K antagonist
Brand/generic status
Brand
Generic
What is the generic name?
What is the brand name?
Generic name:
apixaban
(not yet available as generic)
Brand name:
Coumadin
(no longer available as brand)
What form(s) does the drug come in?
Tablet, Starter pack
Tablet
What is the standard dosage?
2.5 mg or 5 mg by mouth twice a day; dosage varies by indication
*Routine
INR
monitoring is not required
Varies based on
INR
blood test
How long is the typical treatment?
Varies
Varies
Who typically uses the medication?
Adults
Adults; sometimes used
off-label
in children
Eliquis is FDA approved to:
Lower
stroke risk
and
systemic embolism
risk in patients with
nonvalvular
atrial fibrillation
Prevent
deep vein thrombosis
(DVT) after hip or knee replacement surgery
Treat DVT or
pulmonary embolism
(PE)
Lower the risk of DVT and PE recurrence
Warfarin is FDA approved to:
Prevent and treat DVT and PE
Prevent and treat complications from
atrial fibrillation
and/or cardiac valve replacement
Lower the risk of death, recurrent
heart attack
, and clotting events such as stroke, after a
heart attack
Warfarin does not treat an established clot or reverse tissue damage. Once a clot has occurred, warfarin can be used to prevent the clot from growing and to prevent complications that can be serious or fatal.
Many doctors are more commonly prescribing factor Xa inhibitors such as Eliquis. Because there is no INR monitoring, the dosage generally does not require adjustments. Also, there are fewer drug interactions, no dietary restrictions, and a lower risk of bleeding with Eliquis compared to warfarin.
A clinical trial called ARISTOTLE looked at the safety and efficacy of Eliquis compared to warfarin. Eliquis was found to be more effective than warfarin in lowering the risk of stroke and systemic embolism. People who took Eliquis also had significantly fewer bleeding episodes than those who took warfarin. However, although this study showed Eliquis to be more effective and cause fewer side effects, many people do very well on warfarin.
The best drug for you can only be determined by your healthcare provider, who can take into account the full picture of your medical condition(s), medical history, and other medications you take that could interact with Eliquis or warfarin.
Eliquis is usually covered by insurance and Medicare prescription plans, but the copays vary. A typical Eliquis prescription for a one-month supply of 60, 5 mg tablets would cost about $635 if you pay out of pocket. However, you can use a SingleCare coupon to save money on Eliquis, lowering the price to approximately $475.
Warfarin is usually covered by insurance and Medicare prescription plans, with varying copays. A typical warfarin prescription for a one-month supply (30 tablets of 5 mg) would cost about $23 without insurance. You can use a SingleCare card to receive the medication for $4 or even less.
Eliquis WarfarinTypically covered by insurance?
Yes
Yes
Typically covered by Medicare Part D?
Yes
Yes
Standard dosage
#60, 5 mg tablets
#30, 5 mg tablets
Typical Medicare Part D copay
$19-$541
$0-$15
SingleCare cost
$475 +/-
$1+
The most common side effects of Eliquis and warfarin are related to bleeding. Examples include nosebleeds, bruising, blood in the urine, or bleeding gums. In rare instances, bleeding can be serious or life-threatening. The risk of bleeding can increase when Eliquis or warfarin is taken with other drugs (see drug interactions section).
Also, there is an increased risk of bleeding in patients who take warfarin who have or have had serious heart disease, high blood pressure, history of stroke or mini-stroke, cancer, kidney problems, stomach or intestinal bleeding, or an accident or surgery. There is also an increased risk of bleeding from warfarin in adults ages 65 years and older, and patients of any age who have taken warfarin for a long time.
Besides bleeding, other common side effects of Eliquis are:
Anemia
Nausea
In addition to bleeding, other common side effects of warfarin include:
Stomach problems such as cramping/pain, nausea, vomiting, diarrhea, bloating, gas
Fatigue
General discomfort
Weakness
Headache
Dizziness
Altered taste
Itching/hives/rash
Swelling
Fever
Cold intolerance
Numbness and tingling
Hair loss
Allergic reactions to Eliquis or warfarin are rare. If you experience hives, trouble breathing, or swelling around the face or mouth, seek emergency medical attention immediately.
This is not a complete list of side effects—other adverse effects may occur. Consult your healthcare provider for more information on adverse reactions to Eliquis and warfarin.
Source: Epocrates (Eliquis), Epocrates (warfarin)
Before taking Eliquis or warfarin, it is very important to review your medication list with your doctor. Tell your doctor about every prescription and OTC drug you take, as well as any vitamins or supplements. Your doctor will check for drug interactions before prescribing Eliquis or warfarin.
Eliquis
drug interactions
Eliquis interacts with certain drugs that are metabolized by the same enzyme. When enzyme inhibitor drugs are taken with Eliquis, Eliquis levels in the body increase, which can increase the risk of bleeding. If you must take this combination of drugs, your doctor will likely decrease your Eliquis dose while you are taking both medications.
On the other hand, when enzyme inducers are taken in combination with Eliquis, there is an interaction where Eliquis is metabolized faster, and you may not get the full amount of the Eliquis dose. This could increase the risk of stroke and other clotting events.
Taking Eliquis with other anticoagulants, antiplatelet drugs, nonsteroidal anti-inflammatory drugs (NSAIDs), or certain antidepressants, may increase the risk of bleeding.
Examples of drugs that interact with Eliquis:
Drugs that thin the blood: clopidogrel, enoxaparin, heparin,
warfarin
NSAIDs
(long-term use): aspirin, ibuprofen, meloxicam, nabumetone, naproxen
SNRI antidepressants
: desvenlafaxine, duloxetine, venlafaxine
SSRI antidepressants
: citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline
Strong enzyme inducers: carbamazepine, phenytoin, rifampin, St. John’s Wort
Strong enzyme
inhibitors
: itraconazole, ketoconazole, ritonavir
Warfarin
drug interactions
Warfarin has many drug interactions which require more frequent INR monitoring. Some drugs may even interact by more than one mechanism.
Some drugs interact with warfarin in a way that increases warfarin levels, which would mean that you have more exposure to the medication and it can have a stronger effect, and could cause bleeding. These drugs are known as enzyme inhibitors. Examples of these drugs include:
Antifungals
such as fluconazole, itraconazole, ketoconazole, miconazole, voriconazole
Benzodiazepines
such as alprazolam
Drugs used for
arrhythmia
such as amiodarone and propafenone
Hormonal birth control
Macrolide antibiotics
such as azithromycin, clarithromycin, erythromycin
Quinolone antibiotics
such as ciprofloxacin, levofloxacin
Statins such as atorvastatin, rosuvastatin, simvastatin
SSRI antidepressants such as fluoxetine, paroxetine, sertraline
Other drugs can increase the risk of bleeding when used with warfarin. Examples include:
Anticoagulants
such as heparin or
Pradaxa
(
dabigatran
)
Antiplatelets such as aspirin, Plavix (clopidogrel), cilostazol
NSAIDs
such as celecoxib, diclofenac, ibuprofen, indomethacin, meloxicam, naproxen
SSRI and SNRI antidepressants:
citalopram, desvenlafaxine, duloxetine, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, venlafaxine, vilazodone
Some drugs interact with warfarin in a way that decreases warfarin levels, so warfarin would not be as effective and you could be more likely to have a clotting event. These drugs are known as enzyme inducers. Examples of these drugs are:
Anticonvulsants such as carbamazepine, phenobarbital, phenytoin, rifampin
Leukotriene receptor antagonists such as montelukast
Steroids such as prednisone
The amount of vitamin K in food, commonly in dark leafy greens, can affect warfarin levels. It is best to eat a consistent amount of vitamin K, and avoid drastic changes in diet.
This is not a full list of drug interactions. Consult your healthcare provider for more information.
Eliquis
warnings
Eliquis has a boxed (black box) warning, the strongest warning required by the FDA. The warning states:
Discontinuing
Eliquis
too soon increases the risk of a clotting event.
Epidural or spinal hematoma may occur in patients receiving neuraxial (between vertebrae) anesthesia or spinal puncture. The hematoma may result in long-term or even permanent paralysis. The risk is higher in patients with epidural catheters, patients taking other medications that affect blood flow, patients with a history of traumatic or repeated punctures, and patients with a history of spinal deformity or surgery. Patients should be frequently monitored for signs and symptoms of neurological impairment. Symptoms may include numbness and weakness of the legs, and bowel and bladder problems. If any issues occur, the patient should seek emergency medical attention.
Other warnings of Eliquis include:
Bleeding may occur as a
side effect
of
Eliquis
.
Bleeding events
may be serious (
major bleeding
) or potentially fatal. Using
Eliquis
with certain drugs, such as
anticoagulants
, antiplatelet drugs,
NSAIDs
, or SSRI or SNRI antidepressants, increases
bleeding risk
. Patients with bleeding should get emergency medical attention right away. The drug should be stopped in patients with active hemorrhage.
A reversal agent is available to reverse the effects of
factor Xa
inhibition.
Eliquis
should not be used in patients with prosthetic
heart valves
.
Eliquis
should not be used as an alternative to heparin for the initial treatment of PE in patients with hemodynamic instability (shock/
heart failure
).
Eliquis
should not be used in patients with
triple-positive antiphospholipid syndrome (APS), due to an
increased risk
of clotting.
People with liver or kidney problems should consult their
healthcare provider
before taking
Eliquis
.
Eliquis use in pregnancy:
There is limited data regarding Eliquis use in pregnancy. Eliquis can increase the risk of bleeding during pregnancy and delivery. It can also increase the risk of bleeding in the fetus and newborn. Using Eliquis during labor or delivery in women receiving an epidural may cause epidural or spinal hematomas. A shorter-acting anticoagulant may be used if needed. Consult your OB-GYN about Eliquis use during pregnancy. Generally, Eliquis is only prescribed if the benefits outweigh risks, for example, in certain high-risk pregnancies, and with close monitoring. If you already take Eliquis and find out that you are pregnant, consult your OB-GYN for medical advice.
Warfarin
warnings
Warfarin also has a black box warning. The warning states:
Warfarin
may cause major or fatal bleeding.
People who take
warfarin
should have regular monitoring of
INR
levels.
INR
levels can be affected by other drugs as well as dietary changes.
Patients who take
warfarin
should learn about measures to minimize
bleeding risk
, and should promptly report signs of bleeding or seek emergency medical attention if needed.
Other warfarin warnings:
Warfarin
can cause
major bleeding
, which can be fatal. Bleeding is more likely to occur in the first month of treatment. Certain patients are at higher risk. Talk to your doctor about how to minimize the chance of bleeding.
INR
should be regularly measured, but even if
INR
stays in the
therapeutic range
, there is still a chance of bleeding.
In rare cases,
warfarin
can cause necrosis or gangrene of the skin or other tissues. This may require medical removal of the tissue or amputation. If this occurs, your doctor will change
warfarin
to another medication.
Warfarin
can cause complications in people with kidney failure.
Warfarin
can also cause kidney injury in patients with kidney problems or a history of kidney disease.
Warfarin
should not be used as initial treatment in patients with
heparin-induced thrombocytopenia (HIT)
or heparin-induced thrombocytopenia with thrombosis syndrome (HITTS) because necrosis and gangrene can occur, which may lead to amputation or death.
Some conditions increase the risks associated with
warfarin
. These include liver problems, infections, an indwelling catheter, high
blood pressure
, a deficiency in protein C-mediated
anticoagulant
response, eye surgery, diabetes, vasculitis, and
polycythemia vera
.
INR
can be affected by factors such as diarrhea, liver problems, nutritional state, or
vitamin K
intake.
Warfarin use in pregnancy:
Warfarin can cause harm to an unborn baby. Warfarin should not be used in pregnant women. The only exception is in pregnant women with mechanical heart valves at high risk for clots, where the benefits outweigh the risks. Women of childbearing age should use effective contraception while taking warfarin and for at least one month after the last dose of warfarin.
How to stay safe while taking a
blood thinner
Taking a blood thinner can make you more likely to bleed, so it’s important to take steps to prevent bleeds. Here are some tips:
Get emergency medical attention right away if you fall or hit your head. Even if you are not bleeding, you may be bleeding under the skin or in your skull.
Be careful when using sharp objects like knives, scissors, and razors. Better yet, use an electric razor.
For dental care, use a soft toothbrush, waxed floss, and avoid toothpicks.
Avoid activities that could cause injury. Ask your doctor what type of exercise is appropriate for you, such as swimming or walking.
Wear a helmet when riding a bike.
Wear a medical alert ID that says you take a
blood thinner
.
Wear shoes or non-slip slippers inside. Always wear shoes when outside.
For foot care, be careful when cutting your toenails. Do not try to trim calluses—go to a podiatrist.
When working outside, wear appropriate gloves for using sharp tools or working in the yard.
What is
Eliquis
?
Eliquis is an anticoagulant, or blood thinner. It is classified in a group of drugs known as factor Xa inhibitors. Eliquis is in the same drug class as Xarelto (rivaroxaban) and Savaysa (edoxaban).
What is
warfarin
?
Warfarin is also an anticoagulant, or blood thinner. It is commonly known by the brand name of Coumadin, which is no longer commercially available.
Are
Eliquis
and
Warfarin
the same?
Eliquis and warfarin are both blood thinners and can be used to prevent or treat blood clots. Although both drugs are blood thinners, they are not the same. They work differently and have differences in terms of dosing, monitoring requirements, and drug interactions. They both cause bleeding as the main side effect, but other side effects are not the same. The information above outlines the differences between the two drugs.
Is
Eliquis
or
Warfarin
better?
In the ARISTOTLE study (see above), Eliquis was concluded to be more effective than warfarin. Eliquis also caused fewer bleeding episodes. Eliquis also does not require monitoring, has fewer drug interactions, and is not affected by vitamin K intake. However, since every person has a unique medical history, only the doctor can determine if Eliquis or warfarin would be better.
Is
Eliquis
safer than
warfarin
?
In a study that compared Eliquis and warfarin, Eliquis was shown to cause fewer bleeds events. However, many people take either Eliquis or warfarin safely. Talk to your doctor to find out which one is more appropriate for you.
Can I use
Eliquis
or
Warfarin
while pregnant?
Eliquis is generally only prescribed during pregnancy if the benefits outweigh the risks, generally only in certain high-risk situations. Warfarin should not be used in pregnant women, with the exception of pregnant women who have mechanical heart valves and are at high risk for clots, where the doctor has determined the benefits outweigh the risks. Talk to your doctor if you are pregnant or planning to become pregnant.
Can I use
Eliquis
or
Warfarin
with alcohol?
It is best to avoid alcohol while taking a blood thinner. Alcohol can thin the blood, so combined with a blood thinner drug, the risk of bleeding is higher when alcohol is brought into the equation. Some doctors will give the green light to small amounts of alcohol, however, each person has a different medical situation, so consult your doctor for medical advice regarding alcohol use and blood thinners.
Is there a cheaper alternative to
Eliquis
?
A generic of Eliquis was approved by the FDA but is not yet available. You can use an Eliquis copay card or a free SingleCare card to save money on Eliquis.
What is the safest
blood thinner
to take?
All blood thinners on the market are FDA approved and have undergone testing for safety. Newer blood thinners like Eliquis tend to cause fewer bleeds episodes than warfarin. Your doctor can determine which blood thinner is safest for you, taking into account your medical conditions and other drugs you take that may interact with a blood thinner.
When should I call my doctor about bleeding from
Eliquis
or
warfarin
?
Call your doctor right away if you experience:
Menstrual bleeding that is much heavier than usual
Red or brown urine
Red or tarry bowel movements
Nose bleeding, a cut, or gum bleeding that does not stop quickly
Brown or red vomit
Coughing up anything red
Severe pain (headache or stomach pain)
Unusual bruising
A serious fall or bump on the head
Weakness or dizziness