Eliquis vs. Warfarin: A Cardiologist Reveals Which Blood Thinner Works Best and Is Safer
Plus see an important warning if you have surgery scheduled
Whether you’re trying to prevent blood clots or have been prescribed a blood thinner to treat atrial fibrillation (AFib), Eliquis (apixaban) and warfarin are two of the most commonly-used medications. How do they compare—and how do you know which is right for you? Here, a top cardiologist explains everything you need to know about Eliquis vs. warfarin, including which one can be affected by what you eat.
Eliquis vs. warfarin: What’s the difference?
Before Eliquis came along, the main blood thinners were aspirin and warfarin (Coumadin). “Aspirin is relatively mild—it can help, but it’s not strong enough to fully stop clot formation or prevent clots from growing. It can slow the process, but it doesn’t shut it down,” says preventive cardiologist Elizabeth Klodas, MD.
On the other hand, warfarin can effectively stop clotting, but it works through a vitamin K–related mechanism, so it’s less targeted, she continues. “It also requires frequent blood tests to make sure you’re taking exactly the right dose, which can be challenging. Some people never quite find the right dose—we’re constantly adjusting it up and down”
Woman's World Answers
Warfarin is also affected by diet, particularly foods that influence vitamin K levels, like leafy greens and certain vegetables and fruits. “As a result, patients often have to follow a very consistent, carefully monitored diet, which can be difficult to maintain.”
Finally, warfarin is also associated with a significantly increased risk of bleeding in the brain, Dr. Klodas notes. “That risk exists with Eliquis as well, but it’s lower.”
Eliquis vs. warfarin: Which is right for you?
Considering ease of use, safety and efficacy, Eliquis may seem like the obvious choice for most, especially for long-term use. So why would your doctor put you on warfarin instead of Eliquis? “Not every single patient with AFib is eligible for Eliquis,” reveals Dr. Klodas.
“There are people who have structural heart issues, specifically valve problems, that have contributed to the development of this irregular heart rhythm. They should be on warfarin because Eliquis doesn’t seem to be effective enough in these cases.”
What to know about blood thinners if you’re having surgery
If you know you’re going to have surgery, you’ll usually need to stop blood thinners such as Eliquis or warfarin ahead of time, though the exact timing depends on the type of procedure, Dr. Klodas points out. “For major surgery, it’s typically stopped about 48 hours beforehand. Eliquis is taken twice daily, and its blood-thinning effect is significantly reduced after about 24 hours, so it doesn’t stay in your system for very long.”
Warfarin, on the other hand, is typically stopped five days before surgery. “Then, INR—the blood test used to measure how thin the blood is while on warfarin—should be checked a day or two before elective surgery to make sure it falls below 1.5,” she adds.
For minor procedures, this type of medication is often stopped about 24 hours in advance. One key exception: “For procedures involving needles near the spine, such as an epidural injection, it may be stopped closer to 72 hours beforehand. That’s because doctors want to minimize any risk of bleeding in or around the spinal canal, which could cause dangerous pressure to build up around the brain,” Dr. Klodas explains.
Could a generic version of Eliquis be coming soon?
One drawback of Eliquis compared to warfarin doesn’t have anything to do with its effectiveness—simply put, it’s expensive. In fact, that’s part of the reason why some people end up taking the less costly blood thinner warfarin. The good news? “Eliquis will reach the end of its patent protection in November 2026, and it’s possible we may have a more affordable generic form,” reveals Dr. Klodas.
However, she notes that as with many things in healthcare, there’s no guarantee a generic will become widely available, since patent challenges and legal delays may be coming down the pike. Still, it’s a promising possibility.
Ready for more inspiration? Subscribe to our YouTube channel for video podcasts, health tips and uplifting stories designed for women 40, 50, 60 and beyond
Conversation
All comments are subject to our Community Guidelines. Woman's World does not endorse the opinions and views shared by our readers in our comment sections. Our comments section is a place where readers can engage in healthy, productive, lively, and respectful discussions. Offensive language, hate speech, personal attacks, and/or defamatory statements are not permitted. Advertising or spam is also prohibited.
