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Drug vs. Drug

Eliquis vs. Plavix: Key differences, uses, costs, and side effects

Eliquis and Plavix are blood thinners with different uses and costs. Explore their unique benefits, side effects, and ways to reduce costs.
By | Updated on Nov. 5, 2024
Two Rx pills respresenting Eliquis vs. Plavix

Key takeaways

  • Eliquis and Plavix are both medications that thin the blood and reduce blood clotting potential but through very different mechanisms.

  • While Eliquis is used to prevent and treat blood clots in situations like atrial fibrillation, deep vein thrombosis, and stroke, Plavix is used to reduce clotting in situations like heart attacks, strokes, and the peripheral arteries of our limbs.

  • The drugs carry similar side effect potentials that center around excess bleeding, and they each have a number of drugs that they negatively interact with.

  • In their brand name forms, both Eliquis and Plavix carry a hefty price tag, but Plavix comes in a generic form, clopidogrel, which is much cheaper.

  • Both antithrombotic drugs, Eliquis and Plavix, can be obtained at a significant savings with a SingleCare discount card.

In this article:

Two widely-used medications that reduce our ability to form blood clots, Eliquis and Plavix have very different uses and prices. Eliquis (apixaban) is only available as a brand-name tablet taken twice daily to treat or prevent blood clots in the heart, blood vessels, or lungs. Plavix (clopidogrel) has both brand and generic tablets available and put to use in the setting of heart attack, stroke, or peripheral arterial disease. Insurance may cover either one, but if not, the monthly price without insurance of Eliquis can be $780 for 60, 5 mg tablets compared to Plavix’s generic form, clopidogrel, which retails for $190 for 30, 75 mg tablets. Let’s drill down on the details of these drugs to prepare you for discussing them with your doctor.

What are the main differences between Eliquis and Plavix?

Main differences of Eliquis versus Plavix
Eliquis Plavix
Drug class Anticoagulant Antiplatelet agent
Brand/generic status Brand Brand with generic available
What is the generic name? Apixaban Clopidogrel
What form(s) does the drug come in? Tablet Tablet
What is the standard dosage? 5 mg twice daily 75 mg once daily
How long is the typical treatment? Variable (months to years) Variable (weeks to years)
Who typically uses the medication? Adults Adults

Conditions treated by Eliquis and Plavix

Eliquis is a direct oral anticoagulant (DOAC) that thins the blood by inhibiting Factor Xa, a clotting factor that is critical for clot formation. One of the most common uses of the drug is stroke prevention in the setting of heart arrhythmia atrial fibrillation (Afib). However, it can also be used to treat and prevent deep vein thrombosis and pulmonary embolism, blood clots in the deep veins and lungs respectively. Depending on the situation, Eliquis could be prescribed for 3-6 months, such as with the treatment of blood clots, or lifelong in the setting of atrial fibrillations or recurrent or life-threatening clotting.

Despite being an antithrombotic like Eliquis, Plavix falls under a different subclass, called antiplatelet agents. It inhibits the action of platelets, our blood cells which help to form clots. Classic uses for Plavix include during and after a myocardial infarction (heart attack) or stroke, as it can have treatment and prevention roles in these settings. When atherosclerosis has created calcified cholesterol blockages in the arteries of the heart, brain, or limbs, Plavix may be prescribed short-term or long-term to keep the blood flowing by preventing thrombosis or clot at those sites.

Conditions treated by Eliquis and Plavix
Condition Eliquis Plavix
Atrial fibrillation Yes No
Venous thromboembolism Yes No
Acute coronary syndrome No Yes
Thrombotic event risk reduction No Yes
Clot prevention after arterial stents No Off-label
Clot prevention after transcatheter valve surgery No Off-label
Alternative to aspirin No Off-label
Left ventricular thrombus in heart Off-label No
Heparin-induced thrombocytopenia Off-label No

Is Eliquis or Plavix more effective?

Because they have different approved indications from the Food and Drug Administration (FDA) and off-label uses, Eliquis and Plavix are not considered competitors. They each have their unique roles, and depending on the circumstance, either could be preferred or considered more effective. When stroke risk is high in the setting of Afib, Eliquis may be called upon, but when someone is having an impending heart attack, Plavix could be the pick.

A more valid comparison between drugs used in similar situations, Eliquis, Xarelto (rivaroxaban), and Jantoven (warfarin) are commonly contrasted anticoagulants. Likewise, Plavix, Brilinta (ticagrelor), and aspirin are compared often to determine which is the better antiplatelet drug. Figuring out which to use is a high-stakes decision that your healthcare provider will make by considering your health conditions and other medications.

Coverage and cost comparison of Eliquis vs. Plavix

If you have prescription drug coverage as part of your health insurance plan, there is a good chance that Eliquis is included on the formulary, although your copay could be relatively high. Plavix is typically excluded from formularies, as a result of its generic version clopidogrel being available, cheaper, and considered equally efficacious. Aetna’s Standard Plan and Humana Medicare’s formularies are good examples of this, but you should consult your formulary to determine coverage.

Without insurance, the retail prices of Eliquis and Plavix are steep. Fortunately, generic clopidogrel is a much less expensive substitute for those prescribed Plavix. However, there are ways to save on either option. A SingleCare discount card can be used for Eliquis or Plavix savings at over 35,000 pharmacies across the country.

Eliquis vs. Plavix costs
Eliquis Plavix
Typically covered by insurance? Yes No but generic covered
Typically covered by Medicare Part D? Yes No but generic covered
Quantity 60, 5 mg tablets 30, 75 mg tablets
Typical Medicare copay Free to $12 Free to $1 for generic
SingleCare cost $490 $17 for generic

Common side effects of Eliquis vs. Plavix

As with any antithrombotic drug, bleeding is the primary concern with both Eliquis side effects and Plavix side effects. The medications impair the formation of blood clots, and as a result, bleeding can result, ranging from a common side effect like simple bruising to a serious side effect like a life-threatening hemorrhage. Bleeding in the brain or intestinal tract can be a critical adverse event. Your healthcare provider can help you to understand your particular risks.

Eliquis Plavix
Side Effect Applicable? Frequency Applicable? Frequency
Major bleeding Yes 2.13% per year Yes 3.7% when used with aspirin
Intracranial hemorrhage Yes 0.33% per year Yes 0.4%
Hemorrhagic stroke Yes 0.24% per year Yes 0.1% when used with aspirin
Gastrointestinal bleed Yes 0.83% major per year Yes 2%
Minor bleeding Yes 11.7% Yes 5.1% when used with aspirin

Source: Eliquis and Plavix drug labels.

Drug interactions of Eliquis vs. Plavix

Eliquis and Plavix are metabolized very differently, resulting in distinctive drug interactions. These interactions are important to recognize. If a negative drug interaction leads to excessive levels of either antithrombotic, bleeding complications could result. On the contrary, if an interaction with another prescription drug, over-the-counter medicine, or supplement reduces the effectiveness of Eliquis or Plavix, the result could be a blood clot, heart attack, or stroke. 

Drug Drug Class Eliquis Plavix
Tegretol (carbamazepine) Anticonvulsant Yes No
Dilantin (phenytoin) Anticonvulsant Yes No
Mysoline (primidone) Anticonvulsant Yes No
St John’s Wort Antidepressant supplement Yes No
Sporanox (itraconazole) Antifungal Yes No
Paxlovid (nirmatrelvir and ritonavir) Antiviral Yes Yes
Nonsteroidal anti-inflammatories Analgesic and anti-inflammatory Yes Yes
Prilosec (omeprazole) Antacid No Yes
Nexium (esomeprazole) Antacid No Yes
Rifadin (rifampin) Antibiotic Yes Yes
Diflucan (fluconazole) Antifungal Yes Yes
Grapefruit juice Food Yes Yes

Warnings of Eliquis and Plavix

The FDA has placed black box warnings on both drugs. Eliquis is called out for the risk of spinal bleeding after spinal puncture procedures and for being associated with elevated clotting risk upon discontinuation. The warning about Plavix cites that the drug could be less effective in people with reduced ability to convert it to its active metabolite due to genetic differences.

Additional concerns could apply depending on a person’s health conditions. In the setting of kidney disease, Eliquis may need to be dosed differently. While pregnant or breastfeeding, decisions about Plavix use will come down to a careful analysis of benefits and risks, but Eliquis is typically avoided due to a lack of safety data.

Patients going for surgery present a problem. Bleeding risk during surgery must be accounted for when deciding if and when to withhold Eliquis or Plavix prior to a procedure. Your healthcare team must be called upon to determine how to handle an antithrombotic around the time of surgery.

Frequently asked questions about Eliquis vs. Plavix

What is Eliquis?

Eliquis is an anticoagulant that thins the blood by inhibiting Factor Xa. It is used for prevention and treatment of blood clots, including stroke prevention in the setting of Afib.

What is Plavix?

Plavix is an antiplatelet agent that reduces blood clotting by inhibiting platelet function. The drug is prescribed for acute coronary syndrome, in which a heart attack is occurring or impending, as well as the prevention of thrombotic events like strokes.

Are Eliquis and Plavix the same?

Although they are both antithrombotic agents, Eliquis falls under the subcategory of anticoagulant, and Plavix falls within the antiplatelet subgroup. Their uses, both approved and off-label, are quite different.

Is Eliquis or Plavix better?

Eliquis and Plavix each have circumstances in which they may be preferred. Your primary care doctor or specialist will help to determine the better agent for your particular health condition.

Can I use Eliquis or Plavix while pregnant?

The use of either antithrombotic agent during pregnancy will depend on the risks and benefits of taking it. Since Plavix has been on the market longer, there is more data and experience with it than with Eliquis during pregnancy. Getting the medical advice of the healthcare professionals on your treatment team is essential when making this decision.

Can I use Eliquis or Plavix with alcohol?

There is no direct interaction of alcohol with either drug and no absolute contraindication to its use with either. However, alcohol can increase the risk of bleeding, which poses a hazard to those on Eliquis or Plavix. Talk to your healthcare provider to determine if you should limit or avoid alcohol use.

Can you take Eliquis and Plavix together?

Despite both agents thinning the blood, they are sometimes used together. Their different mechanisms can suggest concurrent use when health conditions are comorbid, for instance, a heart attack in an individual with atrial fibrillation. Because there could be a higher risk of bleeding with coinciding use of Eliquis and Plavix, any decision to do so must be made with utmost caution by your care team of doctors and pharmacists. 

Is Plavix a good blood thinner for Afib?

The FDA has approved Eliquis for the prevention of stroke in the setting of Afib. Plavix is not approved for this use and is much less commonly prescribed for this condition.

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