Warfarin vs. Eliquis: 7 Differences Between These Blood Thinner Medications
Key takeaways:
Warfarin (Coumadin, Jantoven) and Eliquis (apixaban) are both blood thinners. But they work in different ways to prevent blood clots. And there are several other differences to consider between warfarin versus Eliquis.
Eliquis starts working within a few hours, doesn’t require frequent blood tests, and isn’t affected by your diet. Warfarin can take up to 5 days to reach full effects, requires regular blood tests, and you need to follow a consistent diet while taking it.
Many medications, supplements, and even certain foods can interfere with warfarin. Eliquis has fewer interactions, but it’s still important to check with your prescriber or pharmacist before starting or stopping any medications or supplements.
Warfarin and Eliquis are both available as brand-name medications. But you can also find warfarin as a lower-cost generic. GoodRx can help make your prescription more affordable.
Table of contents
Blood clots can be dangerous when they form in places they shouldn’t. A clot that travels to your brain, heart, or lungs can lead to serious health problems. This includes a stroke, heart attack, or pulmonary embolism (PE). That’s where blood thinners come in. They help treat and prevent unwanted blood clots to avoid these issues.
Warfarin (Coumadin, Jantoven) and Eliquis (apixaban) are two commonly prescribed blood thinners. Warfarin has been around for decades, while Eliquis is a newer type of blood thinner. Both are effective options, but there are many differences to consider between these two medications. Here, we’ll compare warfarin versus Eliquis to help you understand how they differ and which one might be right for you.
1. Warfarin and Eliquis are different types of blood thinners
Warfarin and Eliquis are both blood thinners, but they belong to different drug classes and work in different ways.
Warfarin is a vitamin K antagonist. Your body needs vitamin K to make certain proteins, called clotting factors, that help your blood clot. Warfarin lowers vitamin K levels, which makes it harder for blood clots to form.
Eliquis belongs to a group of medications called direct-acting oral anticoagulants (DOACs). DOACs are also referred to as factor Xa inhibitors, because they work by blocking a specific clotting factor, called factor Xa.
In addition to working differently, warfarin and Eliquis have slightly different uses. For example, warfarin is FDA approved to prevent blood clots for people with mechanical heart valves, but Eliquis isn’t. So when it comes to warfarin versus Eliquis, one may be a better fit than the other based on your medical needs.
Blood thinner 101: Learn the difference between two types of blood thinners: antiplatelet and anticoagulant medications.
Warfarin and your diet: You don’t have to give up spinach if you’re taking warfarin (Coumadin, Jantoven). But you do need to follow these tips to prevent it from affecting your medication.
NSAIDs and blood thinners: These two medications should not be taken at the same time. Here’s why.
2. Warfarin requires frequent blood tests, but Eliquis doesn’t
You’ll need regular blood tests to make sure your warfarin dosage is safe and effective. This test is typically referred to as a PT / INR (prothrombin time / international normalized ratio). It measures how long it takes for your blood to form a clot. If your INR is too low, you’re at risk for clots; if it’s too high, you’re at risk for bleeding.
You’ll likely need your blood checked at least once a month while taking warfarin once your dosage is stable. But at first it may be as often as twice a week. Your healthcare team will adjust your warfarin dosage based on the results of your PT / INR tests. So your dosage may change over time.
Eliquis has more predictable effects, so it doesn’t require frequent blood tests. This makes Eliquis a more convenient option than warfarin for most people.
3. Warfarin and Eliquis follow different dosing schedules
Warfarin and Eliquis are also different when it comes to their available doses and dosage schedules.
Warfarin tablets come in nine different doses:
1 mg
2 mg
2.5 mg
3 mg
4 mg
5 mg
6 mg
7.5 mg
10 mg
We need a wide variety of warfarin doses because everyone responds differently to it. Its effect on your blood can vary widely based on your genes, other medications and supplements you take, and even what you eat (more on that later).
Your healthcare team will customize your warfarin dosage to your specific needs. This means some people may take different doses of warfarin from day to day. Others may need to skip warfarin on certain days. It’s important to follow your personal dosage schedule carefully to ensure your PT / INR stays within a safe and effective range.
Eliquis dosages, on the other hand, are much more straightforward. It comes in 2.5 mg and 5 mg tablets. It’s also available in 0.15 mg Sprinkle Caps and 0.5 mg tablets for oral suspension (liquid) for children.
Most adults take 2.5 mg to 5 mg of Eliquis twice a day. You may need a different dosage based on your other health conditions or certain drug interactions, but your dosage is unlikely to change over time.
4. Eliquis starts working faster than warfarin
Eliquis starts working within a few hours and reaches full effect after about 3 days of treatment. Warfarin, on the other hand, usually takes around 5 days to provide its full benefit. The difference comes down to how each medication works.
Because of the delayed onset with warfarin, you may need to use a fast-acting blood thinner until it starts working. This is called bridging therapy, and often involves injectable medications such as Lovenox (enoxaparin) or heparin. Not everyone needs bridging therapy when starting warfarin. Your prescriber will let you know based on your personal history. Bridging isn’t needed with Eliquis, since it starts working faster than warfarin.
Good to know: If you need to stop taking warfarin before a surgical procedure, you may also need bridging therapy before and after surgery. But in most cases, you can stop taking Eliquis before a surgery and restart it afterward without bridging therapy.
5. You’ll need to monitor your diet while taking warfarin, but not with Eliquis
When you’re taking warfarin, a consistent diet is key. Foods high in vitamin K, such as spinach, broccoli, and lettuce, can make warfarin less effective. You don’t have to avoid these foods while taking warfarin. But it’s best to be consistent with what and how much of them you’re eating from week to week. Keeping a food journal can help with this. It can also help your prescriber determine if a sudden change in your PT / INR level may be due to what you’ve eaten recently.
Avoid making big changes to your diet without checking in with your healthcare team. Together, you can come up with a plan to make sure your PT / INR stays in the right range. This may require more frequent blood tests or a change to your warfarin dosage.
Unlike warfarin, what you eat doesn’t affect Eliquis. So you don’t need to keep track of your diet while you’re taking it.
6. Eliquis has fewer drug interactions than warfarin
Eliquis and warfarin can both raise your risk of bleeding. And this risk goes up if you’re also taking other medications that make bleeding more likely. This includes nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil (ibuprofen). It also includes selective serotonin reuptake inhibitors (SSRIs), such as Zoloft (sertraline).
Both blood thinners may also interact with some antifungal and antiseizure medications, as well as St. John’s wort supplements.
When it comes to other interactions, warfarin has a much longer list of them than Eliquis does. Common examples of warfarin interactions include antibiotics, statins, and herbal supplements.
Other Eliquis interactions include diltiazem (Cardizem CD) and some antiviral medications.
When it comes to warfarin versus Eliquis, one may be a better choice than the other based on what other medications you’re taking. Sharing your medication list with your healthcare team can help them make the best choice for you.
7. Warfarin is available as a lower-cost generic, while Eliquis is currently brand-name only
Warfarin and Eliquis are both available as brand-name medications. But you can also find warfarin as a lower-cost generic. GoodRx can help you navigate the many ways to save on your prescription.
Save with GoodRx. GoodRx can help you save over 80% off the average retail price of the generic version of warfarin. Generic warfarin’s price at certain pharmacies is less than $4.00 with a free GoodRx discount.
Save with a copay savings card. If you have commercial insurance, you may be eligible to pay as little as $10 per month for Eliquis using a savings card from the manufacturer. You may also be able to get a 30-day free trial card from your prescriber in certain cases.
Save with patient assistance programs. If you’re uninsured or underinsured, you may be eligible for Eliquis’s patient assistance program, which offers the medication free of cost.
The bottom line
Eliquis (apixaban) and warfarin (Coumadin, Jantoven) are both blood thinners that lower the risk of serious blood clots. But there are several differences to consider between warfarin versus Eliquis, including how they work in the body.
Warfarin is a lower-cost option with a long track record. But it requires frequent blood tests, dosage adjustments, and a consistent diet. Eliquis offers a more convenient alternative with faster onset, fewer interactions, and no food restrictions. But it’s currently only available as a brand-name medication, so cost may be an issue for some people.
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