Eliquis Vs. Warfarin: A Case Study

Superior Essays
Eliquis vs. Warfarin
Jennifer Lockie
Joliet Junior College

According to the American Heart Association, there are, at minimum, 2.7 million Americans currently diagnosed with atrial fibrillation (a-fib). This condition accounts for 15-20% of strokes. As a result, patients are prescribed an anticoagulation therapy to decrease this risk (What is atrial fibrillation, 2016). While warfarin has been the medication of choice for decades, new anticoagulation medications have been approved in recent years that may be more effective with less risk. One of the more recent medications approved is Eliquis (apixaban) (Cassavaugh & Stummer, 2014). Is Eliquis more beneficial for patients with nonvalvular a-fib compared to warfarin? Warfarin was authorized by the FDA in 1954 and Eliquis was authorized by the FDA in 2012. Both medications are used for the prevention of ischemic stroke in patients with nonvalvular a-fib. During a phase 3, double-blinded ARISTOTLE study, patients with nonvalvular a-fib and at least one additional risk factor for stroke were given either Eliquis 5mg BID or adjusted dose warfarin. Patients with two or more of the following risk factors were given Eliquis 2.5mg BID: weight of 60 kg or less, age of 80 years or more, or SCr of 1.5 mg/dL or greater. This study found that Eliquis was superior to warfarin in regards to reduction of stroke, systemic embolism and major bleeding. In regards to peptic ulcer disease and GI issues, neither Eliquis nor warfarin had an increased risk for development (Drug class review, 2013). Eliquis works by prohibiting factor Xa in the clotting sequence, which lowers the chance of blood clot formation (Cassavaugh & Stummer, 2014). This is an important distinction from warfarin as the mechanism of action does not require any special dietary considerations when taking Eliquis (Drug class review, 2013). Warfarin works by preventing the production of vitamin K-dependent clotting factors. These factors include anticoagulant proteins C and S as well as factors II, VII, IX, and X (Drug class review, 2013). Due to this mechanism of action, patients taking warfarin will have to monitor the amount of vitamin K-rich foods they consume. Some examples of these foods include green leafy vegetables, broccoli, spinach, Brussel sprouts, or kale; soybeans; coleslaw; kiwifruit; and tuna in oil. While these foods do not need to be eliminated from the patient’s diet, they will need to be consumed consistently. Increased ingestion of these foods may lower the effectiveness of warfarin, increasing the risk of blood clots and stroke (A Patient's Guide to Taking Warfarin, 2014). In normal circumstances, Eliquis does not require routine blood test monitoring to verify the therapeutic range, whereas warfarin requires consistent monitoring of PT/INR blood tests to verify therapeutic range and adjust the dosage as needed (Cassavaugh & Stummer,
…show more content…
The INR is a specific mathematical calculation of the PT or prothrombin time. This test is used to monitor the efficacy of anticoagulation therapy. The therapeutic range for patients taking warfarin is an INR of 2.0 to 3.0 (Malarkey & McMorrow, 2012, p.526). If the patient’s INR is too low, then the medication is not reaching its therapeutic goal. If the INR results are too high, then the patient will be at an increased risk of bleeding. Factors that can modify the effectiveness of warfarin and increase/decrease the PT/INR include medications, alcohol, and foods containing vitamin K (A Patient's Guide to Taking Warfarin, 2014). If patients taking Eliquis experience increased bleeding or need surgery, the doctor may order a PT/INR or anti-factor Xa tests to gauge the patient’s coagulation factors (Guidelines for the Management of Anticoagulant, …show more content…
(n.d.). Retrieved October 18, 2016, from http://reference.medscape.com/drug/lovenox-enoxaparin-342174

Guidelines for the Management of Anticoagulant and Anti-Platelet Agent Associated Bleeding Complications in Adults. (n.d.). Retrieved October 18, 2016, from http://wsp.mclaren.org/Lapeer/files/Guidelines for the Management of Anticoagulant Agents.pdf

Kreuziger, L. M., Keenan, J. C., Morton, C. T., & Dries, D. J. (2014, July 20). Management of the Bleeding Patient Receiving New Oral Anticoagulants: A Role for Prothrombin Complex Concentrates. Retrieved October 18, 2016, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4127295/

Malarkey, L. M., & McMorrow, M. E. (2012). Saunders Nursing Guide to Laboratory and Diagnostic Tests (2nd ed.), p.526. St. Louis, MO: Elsevier/Saunders.

VHA Pharmacy Benefits Management Services, Medical Advisory Panel, and VISN Pharmacist Executives. Drug Class Review: Target Specific Oral Anticoagulants Dabigatran (Pradaxa), Rivaroxaban (Xarelto), and Apixaban (Eliquis). (2013, September). Retrieved October 18, 2016, from

Related Documents

  • Superior Essays

    Therefore, the outcomes of DAT should have a clinical correlation with a particular condition like hemolysis due to…

    • 1036 Words
    • 5 Pages
    Superior Essays
  • Improved Essays

    Generic name: Aspirin Classification: Therapeutic: antipyretics, nonopioid analgesics; Pharmacologic: salicylates Therapeutic use: Slows the blood’s clotting action by reducing the clump of platelets, this helps to put a stop to or reduce blood clots.…

    • 1272 Words
    • 6 Pages
    Improved Essays
  • Improved Essays

    1. Discuss the pathophysiology related to CVA due to thrombus vs. embolus. Describe the stages in the development of an atheroma. There are a few different pathophysiologies that can lead to a stroke.…

    • 1404 Words
    • 6 Pages
    Improved Essays
  • Improved Essays

    Ap Case Study Eliot

    • 946 Words
    • 4 Pages

    Reducing the effect of warfarin will lower the INR and stop the bleeding episodes. Henceforth, cimetidine to be discontinue from Eliot’s medication list and an alternative antacid such as Pepcid will be considered at this time (Anticoagulation EUROPE (UK), 2015). Digoxin- Pseudoephedrine interaction: Using digoxin together with pseudoephedrine can cause an irregular heart rhythm. Pseudoephedrine is a sympathomimetic agent, which can activate β-receptors of the heart leading to increases in heart rate and α-receptors in vascular smooth muscle leading to vasoconstriction and increases in blood pressure (Sager et al., 2013).…

    • 946 Words
    • 4 Pages
    Improved Essays
  • Great Essays

    Due to the issue originating in the liver, hemin is most effective best when given intravenously, to avoid the first pass mechanism in the body. This allows hemin to reach the liver before the body is able to metabolize the drug. Like any drug, prophylactic hemin has side effects that should be monitored by medical…

    • 1580 Words
    • 7 Pages
    Great Essays
  • Improved Essays

    Some limitations of warfarin use include a narrow therapeutic index, daily monitoring…

    • 262 Words
    • 2 Pages
    Improved Essays
  • Great Essays

    Evolocumab Research Paper

    • 1540 Words
    • 7 Pages

    Each group received an injection right under the skin every two weeks. One group received an injection with the active ingredients, and the placebo group received an injection without. The efficacy end point, which tests whether the hypothesis is true or not, was determined by cardiovascular events. These events include cardiovascular death, angina or chest pain, a myocardial infarction, or coronary revascularization. Coronary revascularization is a procedure in which they bypass an artery to restore blood flow to the heart.…

    • 1540 Words
    • 7 Pages
    Great Essays
  • Improved Essays

    Always check with your health care provider before taking any medicine. You will need to avoid over-the-counter medicines that can affect the clotting process. Some of these are: Aspirin and other drugs that contain salicylates. Nonsteroidal anti-inflammatory drugs (NSAIDs). Exercise Exercise regularly and maintain a healthy weight.…

    • 716 Words
    • 3 Pages
    Improved Essays
  • Great Essays

    Mast's Vepoloxamer

    • 2000 Words
    • 8 Pages

    Title: This Week in Pharma: Is Anavex’s Hype Based on Data or Anecdotes? Can Mast’s Vapoloxamer be successful a second time around? Summary: This column presents questions on Anavex’s 2-73 and Mast’s Vepoloxamer. Based on your votes for the more interesting topic, Slingshot Insights will sponsor the expert’s cost.…

    • 2000 Words
    • 8 Pages
    Great Essays
  • Great Essays

    The Medicines Company Case

    • 1116 Words
    • 5 Pages

    Biogen drop the researches of this drug due to them not believing the benefits did not outweigh the costs. One of the many challenges that Medicines Company has…

    • 1116 Words
    • 5 Pages
    Great Essays
  • Improved Essays

    Since these new drugs haven’t been studied as much, the new drugs can cause an increased risk for bleeding in certain people. Coumadin has been studied for a long time and they have done many tests to make sure that it is completely safe. While there are many pros of taking Coumadin over other drugs there are also some cons. Since there are newer drugs that are similar to Coumadin they are also more advanced than Coumadin in some ways. The new drugs start working a lot faster than Coumadin does and the effects done last long after stopping taking them (Carter, 2017).…

    • 1431 Words
    • 6 Pages
    Improved Essays
  • Improved Essays

    Of the 12 that dropped out of the onabotulinumtoxinA group, three noted that adverse effects caused them to discontinue the study. All other individuals were either lost to follow up. Despite these limitations, this study was important for clinical practice because it allows clinicians to better understand the tolerability and efficacy of onabotulinumtoxinA in comparison to topiramate. If a patient has difficulty tolerating the effects of topiramate, this study allows clinicians to better educate their patients on a potentially more tolerable and similarly efficacious alternative.…

    • 784 Words
    • 4 Pages
    Improved Essays
  • Improved Essays

    Movantik And Amitiza

    • 242 Words
    • 1 Pages

    Both drugs are category C in pregnant patients, due to lack of studies. In lactating patients, both drugs…

    • 242 Words
    • 1 Pages
    Improved Essays
  • Improved Essays

    Variable choice: Medications are an important part of patient care. It has been shown that as the number of medications, the frequency of taking medications or the complexity of the prescription increases the more difficulty patients have in complying with the therapy. Compliance with medications is extremely important as medication non-compliance; misuse and drug-drug interactions may cause admission and/or readmission to the hospital, increased length of hospital stay and may lead to serious complications, including organ failure or death. I have long been an advocate for having an accurate medication list at every clinic visit therefore I choose to look at the number of medications the vascular surgery patient population is taking.…

    • 869 Words
    • 4 Pages
    Improved Essays
  • Improved Essays

    General Principles of Software Validation; Final Guidance for Industry and FDA Staff. Clinical studies: Reproducibility: This study showed that the cobas MPX test shows highly reproducible results across sites, lots and days at different concentrations. Clinical specificity: Whole blood donor: A total of 13,306 whole blood donations were tested and the clinical specificity foe individual testing was found to be 99.895%. Similarly, in pool testing the results were found to 99.866% from 10,500 pools tested.…

    • 826 Words
    • 4 Pages
    Improved Essays

Related Topics