Eliquis Vs Plavix (Comparison of Apixaban and Clopidogrel)

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eliquis vs plavix apixaban vs clopidogrel

Eliquis Vs Plavix is a comparison of the two commonly used blood thinners, Apixaban and Clopidogrel. Both drugs have different mechanisms of action and different indications. Generally speaking, Apixaban is an anticoagulant and Clopidogrel is a platelet inhibitor.

Drug Description of Eliquis and Plavix:

  • Eliquis (Apixaban)

    • Eliquis generic name is Apixaban. It is a widely used anticoagulation medication. It prevents thrombin generation and thrombus development.
    • Chemically it is 1-(4-Methoxyphenyl)-7-oxo-6-[4-(2-oxopiperidin-1-yl)phenyl]-4,5,6,7-tetrahydro-1H-pyrazolo[3,4-c]pyridine-3-carboxamide
    • The empirical formula of Eliquis is C25H25N5O4
    • The Molecular Weight of Eliquis is 459.5
  • Plavix (Clopidogrel):

    • Plavix generic name is Clopidogrel. It belongs to the class of drugs called antiplatelet medication.
    • Chemically it is methyl (+)-(S)-α­ (2-chlorophenyl)-6,7-dihydrothieno[3,2-c]pyridine-5(4H)-acetate sulfate (1:1).
    • The empirical formula of this drug is C16H16ClNO2S•H2SO4
    • Clopidogrel molecular weight is 419.9.

Synonyms:

  • Eliquis:

    • Apixaban
    • 503612-47-3
    • BMS-562247-01
    • BMS-562247
    • BMS 562247-01
    • 1-(4-Methoxyphenyl)-7-oxo-6-[4-(2-oxopiperidin-1-yl)phenyl]-4,5,6,7-tetrahydro-1H-pyrazolo[3,4-c]pyridine-3-carboxamide
    • UNII-3Z9Y7UWC1J
  • Plavix:

    • Clopidogrel
    • methyl (+)-(S)-α­ (2-chlorophenyl)-6,7-dihydrothieno[3,2-c]pyridine-5(4H)-acetate sulfate (1:1)

Mechanism of Action of Eliquis Vs Plavix (Apixaban Vs Clopidogrel):

Eliquis (Apixaban):

  • It inhibits enzyme prothrombinase along with free and clot-bound factor Xa.
  • It has no direct effect on platelet aggregation. But, it acts on thrombin-induced platelet assemblage.
  • It interferes with cross-linked clot formation.

Plavix (Clopidogrel):

  • It is an inhibitor of ADP-induced platelet aggregation
  • It prevents the ADP from binding to its receptor. Ultimately, inhibiting the ADP mediated activation of the glycoprotein GPIIb/IIIa complex

Dosage of Eliquis Vs Plavix (Apixaban Vs Clopidogrel):

  • Eliquis:
    • Tablet: 2.5 mg and 5.0 mg. Depending on the concurrent risk factors of bleeding and the indications, it is administered twice daily.
  • Plavix:
    • Tablet: 75.0 mg and 300.0 mg. Depending on the indications, it is administered alone or in combination with aspirin once daily.

Metabolism of Eliquis and Plavix:

Eliquis:

  • It is metabolized by CYP3A4
  • Other enzymes with minor contributions include CYP1A2, 2C8,2C9,2C19, and 2J2
  • There are no active circulating metabolites of this drug

Plavix:

  • It is metabolized by hepatic CYP450 enzymes that generate active metabolites
  • The enzyme esterase metabolizes it to generate inactive metabolites

Dosing Formulations:

  • Both drugs are available in oral tablets formulations that may be administered once or twice daily.
  • Eliquis can be taken along with aspirin and a P2Y12 inhibitor.
  • Plavix can be taken along with aspirin only.

Other features of the two drugs:

Eliquis (Apixaban)

Plavix (Clopidogrel)

Bioavailability 50% >50%
The Onset of Action 1 to 2 hours 2 hours
Peak Serum Time 3 to 4 hours 0.75 hours
Protein binding 87% 98%
Half-life elimination 5 – 6 hours 6 hours (30 minutes for the metabolites)
Excretion
  • Urine: 25%
  • Feces: 25%
  • Renal Clearance 27%
  • Urine: 50%
  • Feces: 50%

 

Drug Interactions of Plavix and Eliquis:

Avoid the following medications when using these two drugs

Eliquis

Plavix

  • Betrixaban
  • Carbamazepine
  • Defibrotide
  • Dexamethasone
  • Fondaparinux
  • Mifepristone
  • Phenytoin
  • Phenobarbital
  • Antithrombin alfa
  • Antithrombin III
  • Argatroban
  • Bivalirudin
  • Dalteparin
  • Fondaparinux
  • Protamine

Indications of Using Eliquis and Plavix:

Common Indications of Using these two drugs

Eliquis

Plavix

  • Nonvalvular Atrial Fibrillation
  • Deep Vein Thrombosis (DVT)
  • Pulmonary Embolism (PE)
  • VTE prophylaxis in Hip and Knee Replacement Surgery
  • Decreases the incident of recurrent VTE and PE
  • Carotid Artery Stenosis
  • Given after post-coronary artery bypass grafting
  • Thromboembolism atrial fibrillation
  • Acute Coronary Syndrome (ACS)
  • Stable Ischemic Heart Disease
  • Use during a percutaneous coronary intervention (PCI) procedure

Common side effects of Eliquis and Plavix:

Common Side effects of these two drugs

Eliquis

Plavix

  • Anaphylactic reaction
  • Skin rashes
  • Allergic edema
  • Hypersensitivity reaction
  • Syncope
  • Anemia
  • Nausea
  • Postural Hypotension
  • Epistaxis
  • Thrombocytopenia
  • Hematemesis
  • Menorrhagia
  • Melena
  • Hematochezia
  • Hematuria
  • Incision site hemorrhage
  • Incision site hematoma
  • Operative Hemorrhage
  • Respiratory Tract Infection
  • Chest Pain
  • Headache
  • Flu-Like symptom
  • Arthralgia
  • Pain
  • Dizziness
  • Skin Rashes
  • Rhinitis
  • Depression
  • Urinary Tract Infection
  • Neutropenia
  • Aplastic Anemia
  • Hepatitis
  • Acute Liver Failure

Warning and Precautions when using Plavix and Eliquis:

Eliquis:

  • Premature Discontinuation of the Eliquis leads to the increased incidence of pathological bleeding. It also results in an increased risk of having a stroke
  • There is an increased risk of epidural and spinal hematoma if Eliquis is used with neuraxial anesthesia
  • Avoid trauma
  • Do not repeat the epidural or spinal puncture
  • While taking the Eliquis, the patient should be monitored for the signs and symptoms of neurological impairment
  • If the patient has an indwelling epidural or intrathecal catheter. Only remove them after 24 hours from the last dose of the drug administered.

Plavix:

  • It should be used with caution in patients with active bleeding or platelet disorders
  • Premature Discontinuation of Plavix increases the risk of Cardiovascular Accidents such as stent stenosis and nonfatal myocardial infarction.
  • Those patients who are allergic to aspirin who has hepatic or renal impairment should use this drug with caution.
  • patients It should be used with care if the patient is already taking aspirin, heparin, warfarin, or any other platelet aggregation inhibitors.

Contraindications to the use of Eliquis and Plavix:

Eliquis:

  • Severe hypersensitivity reaction
  • Active bleeding from anybody site

Plavix:

  • Allergic reaction to any thienopyridine
  • Active pathological bleeding such as intracranial hemorrhage and esophageal varices

Elquis and Plavix Use in Pregnancy:

Eliquis:

There are no sufficient studies done on a pregnant female. However, no case of fetal malformation or miscarriage has been reported so far. But there is an increased risk of fetal or neonatal bleeding.

The Eliquis should only be administered to a pregnant female if the benefits of the drug outweigh its potential risk!

Plavix:

According to the study conducted on this drug over the last two decades. There is been no cause-effect relationship demonstrated in pregnant women using this drug. There is no risk for birth defects and miscarriage.

However, there is an increased risk of maternal bleeding during labor or delivery. So it should be discontinued a week before the labor, delivery, or Caesarian Section.

Eliquis Vs Plavix Use In Stroke Patients:

  • Recently, few effective therapies are being established according to the clinical trial being conducted.
  • Conventionally, antiplatelet therapy such as Clopidogrel with aspirin is being used to treat patients with acute cerebrovascular events. Moreover, Clopidogrel, a platelet adenosine diphosphate receptor antagonist, is effective for the prevention of secondary stroke.
  • The one drawback witnessed during the monotherapy with Plavix is that it could not produce maximal inhibition of platelet aggregation in a conventional dose of 75mg. This poses a hindrance to the early treatment of patients with acute ischemic stroke.
  • Eliquis (Apixaban) a direct factor Xa inhibitor when administered immediately after acute ischemic stroke onset has shown a drastic decrease in the risk for recurrent stroke.
  • However, Eliquis has shown to have an increased tendency of bleeding in patients with stroke as compared to those taking Plavix (Clopidogrel)

Eliquis Vs Plavix Use in Patients with Venous thrombosis:

  • Eliquis, direct factor Xa inhibitors, and direct thrombin inhibitors have shown superior results in preventing and treating venous thromboembolism secondary to atrial fibrillation, surgery, etc with fewer adverse effects than Plavix.
  • Therefore, Eliquis has been approved for treating and preventing thromboembolism in patients who underwent elective hip and knee replacement surgery

Eliquis Vs Plavix Use in Patients with Atrial Fibrillation 

  • Eliquis has shown to have better tolerability in patients with Atrial fibrillation as compared to Plavix.
  • However, in patients with Atrial Fibrillation with a lower risk of stroke development, Plavix is used as an alternative drug
  • A major side effect of Plavix used in these patients is an increased risk of pathological bleeding. Therefore, Eliquis is preferred over Plavix as it does not cause significant hemorrhage.
  • Clopidogrel in combination with Apixaban (Eliquis) is the preferred treatment in patients with Atrial fibrillation undergoing coronary intervention [Ref].
  • In very high-risk patients, where a triple regimen comprising of an anticoagulant, aspirin, and a third antiplatelet is used, clopidogrel should be preferably used (rather than prasugrel or ticagrelor.
  • Similarly, Clopidogrel with Apixaban use was superior to a triple regimen of apixaban, clopidogrel, and aspirin in patients with atrial fibrillation and Acute coronary syndrome [Ref].

Eliquis Vs Plavix Use in Patients with Coronary Artery Disease:

  • Antiplatelet therapy such as Clopidogrel(Plavix) is mainly used to prevent further cardiovascular events in patients who have an acute coronary syndrome.
  • Patients with stable coronary disease are managed with Clopidrogrel monotherapy.
  • However, following the stent placement. Eliquis and Plavix are used as combination therapy. The studies show that patients can be switched to Eliquis alone after 12 months of stent placement.
  • In patients with atrial fibrillation and acute coronary syndrome, the combination of apixaban and clopidogrel was considered superior to either drug alone and safe compared to triple regimen with aspirin.

Eliquis Vs Plavix Use in Patients with Covid-19 Infection:

  • The studies conducted on Covid pneumonia show the increased incidence of thrombotic events in such patients.
  • The use of Eliquis (Apixaban) is recommended for patients with a CHA2DS2-Vasc score of 2 or more in men or 3 or more in women as long as the benefit of anticoagulant outweighs its risk.
  • Apixaban is recommended over Plavix due to large randomized control trials showing superiority over stroke and atrial fibrillation reduction.

Conclusion:

Many studies have been conducted to evaluate the superiority of one drug over the other. However, no clear benefit could be demonstrated. If Eliquis is shown to have a better result in stroke patients. Then the Pravix shows the same in CAD. Thus the differences mainly occur due to patients underlying conditions, comorbidities, tolerability, and research bias.