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Lovenox vs Eliquis
Introduction
For patients at risk of blood clots or stroke, certain medications help prevent clot formation by inhibiting specific proteins involved in the coagulation cascade. Lovenox and Eliquis are two such drugs that are prescribed for this purpose. They each work differently but both have anticoagulant effects in patients with increased clotting risk.
Lovenox, also known as enoxaparin, is a low-molecular-weight heparin (LMWH). It works by blocking factor Xa in the coagulation cascade, which prevents fibrin from forming and thus stops blood clots from developing.
On the other hand, Eliquis or apixaban is classified as a Factor Xa inhibitor too but has direct action on it. This results in prevention of thrombin generation and thrombus development. Unlike Lovenox which requires subcutaneous injections, Eliquis can be taken orally making it a more convenient choice for long-term use.
What is Lovenox?
Enoxaparin (marketed under the brand name Lovenox) was one of the first anticoagulants from the class known as low molecular weight heparins (LMWHs). It received FDA approval in 1993. Lovenox functions by reducing clotting factor Xa's activity, effectively minimizing blood clot formation and is commonly used for treating deep vein thrombosis or pulmonary embolisms. It is also often prescribed to prevent these conditions post-surgery. Enoxaparin has a focused influence on factor Xa with only minor effects on other coagulation factors which results in it having fewer side effects than other anticoagulants that have stronger impacts on these other factors.
Apixaban (sold under the brand name Eliquis), however, belongs to a newer class of drugs called direct oral anticoagulants (DOACs). This medication works by directly inhibiting clotting factor Xa without requiring an intermediary like anti-thrombin III, unlike LMWHs such as enoxaparin. Apixaban provides similar efficacy while offering easier administration and less monitoring compared to enoxaparin.
What conditions is Lovenox approved to treat?
Lovenox and Eliquis are both approved for the treatment of several conditions related to blood clots:
- Prevention of deep vein thrombosis (DVT), which can lead to pulmonary embolism in patients undergoing hip or knee replacement surgery
- Treatment of acute DVT with or without pulmonary embolism
- Reduction in the risk of recurrence of DVT and pulmonary embolism. However, only Eliquis is also approved for reducing the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation.
How does Lovenox help with these illnesses?
Lovenox, also known as enoxaparin, helps to manage and prevent blood clots by inhibiting the formation of fibrin, a protein involved in clotting. It does this by enhancing the activity of antithrombin III, a natural substance in your body that prevents excessive clotting thereby making it harder for clots to form. Fibrin is an essential component of thrombi (blood clots), which can lead to deep vein thrombosis or pulmonary embolism if not properly managed.
Eliquis, on the other hand, works slightly differently as it directly inhibits Factor Xa - another key protein involved in blood coagulation process. This inhibition reduces both thrombin generation and development of thrombi thus preventing strokes or systemic embolism from occurring.
Both drugs are used for prevention and treatment of harmful blood clots but their specific uses depend on various factors including patient's medical history and lifestyle habits. Therefore, before deciding between Lovenox and Eliquis patients should consult with healthcare providers who will consider individual needs when recommending therapy options.
What is Eliquis?
Eliquis, also known as apixaban, is an anticoagulant that was first approved by the FDA in 2012. It works by inhibiting a specific clotting factor (Factor Xa) in the blood to prevent clot formation, thereby reducing the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. Unlike Lovenox or enoxaparin sodium, which is administered through injections under the skin, Eliquis comes in tablet form making it more convenient for daily use. This oral medication also does not require regular monitoring of blood coagulation parameters like its counterpart warfarin. Its side effect profile includes lower risks of major bleeding events compared to traditional anticoagulants such as Lovenox. However, it may cause minor side effects including nausea and minor bruising at injection sites. Eliquis should be used judiciously especially in patients with kidney disease or those on other medications affecting blood clotting.
What conditions is Eliquis approved to treat?
Eliquis is a commonly prescribed medication that has received approval from the Food and Drug Administration for several critical uses. These include:
- Prevention of stroke in people with non-valvular atrial fibrillation (an irregular heart rhythm)
- Treatment and prevention of deep vein thrombosis (DVT, a blood clot usually found in the legs)
- Pulmonary embolism treatment and prevention (a sudden blockage in one of the lung arteries often caused by a DVT moving through your bloodstream)
How does Eliquis help with these illnesses?
Eliquis is an anticoagulant or blood thinner that functions by inhibiting the formation of blood clots. It does this by blocking a specific factor (Factor Xa) in the clotting process. This action reduces the risk of stroke and systemic embolism, particularly in patients with nonvalvular atrial fibrillation (irregular heart rhythm). Unlike Lovenox, which works more directly on thrombin another important protein in the clotting process, Eliquis has a broader reach within the coagulation pathway and doesn't require routine monitoring of blood levels. Additionally, it can be taken orally whereas Lovenox requires subcutaneous injections. Therefore Eliquis might be favored for its ease of use and possibly greater efficacy over time compared to Lovenox.
How effective are both Lovenox and Eliquis?
Both enoxaparin (Lovenox) and apixaban (Eliquis) are effective anticoagulants used to prevent and treat blood clots. Enoxaparin was approved by the FDA in 1993, while apixaban received approval in 2012. They act on different aspects of the coagulation cascade, which can influence their prescription under various circumstances.
Enoxaparin is a low molecular weight heparin that works mainly by enhancing the activity of antithrombin III, leading to inhibition of factor Xa and thrombin (factor II). Apixaban directly inhibits factor Xa without requiring the presence of antithrombin III. A comparison study conducted in patients with acute venous thromboembolism showed both drugs had similar efficacy but differed somewhat in safety profiles; major bleeding events were significantly lower with apixaban compared to enoxaparin followed by warfarin.
Reviews have found that Lovenox has been effective since its introduction for preventing deep vein thrombosis following certain types of surgery or during hospitalization for acute medical illness. It's also useful as a treatment option for established venous thromboembolism and prevention of clotting during hemodialysis.
A review published in 2017 indicated Eliquis provides an alternative oral therapy to warfarin, offering predictable pharmacokinetics across various patient groups including age extremes, body weight ranges, and renal function changes. Unlike Lovenox which requires subcutaneous injections or intravenous administration, Eliquis offers simplified dosing being orally active which can be advantageous for long-term use outside hospitals.
At what dose is Lovenox typically prescribed?
Subcutaneous doses of Lovenox range from 30-40 mg/day for prevention of deep vein thrombosis (DVT), and 1mg/kg body weight every 12 hours or 1.5mg/kg once daily for treatment of DVT or pulmonary embolism. For patients with acute coronary syndrome, the dosage is typically a single IV bolus of 30mg plus a subcutaneous dose of 1mg/kg followed by an injection of 1 mg/kg every twelve hours. On the other hand, Eliquis is usually prescribed as an oral medication at a dosage of either 2.5 mg or 5 mg twice daily, depending on factors such as age, kidney function and body weight. Dosage adjustments may be needed based on individual response to therapy, but in no case should it exceed the maximum recommended dose.
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At what dose is Eliquis typically prescribed?
Eliquis therapy is typically initiated at a dosage of 5 mg taken orally twice daily. For patients who are 80 years or older, weigh less than 60 kg, or have serum creatinine levels greater than 1.5 mg/dL, the recommended dose may be reduced to 2.5 mg twice daily. The maximum dose should not exceed this amount unless specifically advised by a healthcare professional. If there's no positive response after a few weeks of treatment with Eliquis at the prescribed dosage, your doctor may reassess your condition and consider alternative treatment options.
What are the most common side effects for Lovenox?
Common side effects of Lovenox and Eliquis include:
- Bleeding (bruising easily, blood in urine or stools)
- Anemia
- Swelling or discomfort at the injection site (for Lovenox)
- Nausea, vomiting
- Diarrhea or constipation
- Headache
- Dizziness
- Rash, itching or skin reactions -Hypotension (low blood pressure)
In rare cases they can cause more serious conditions such as spinal/epidural hematoma. It is important to contact your healthcare provider immediately if you notice any unusual symptoms while taking these medications.
Are there any potential serious side effects for Lovenox?
In rare cases, Lovenox can lead to serious side effects. Here are some potential ones to look out for:
- Serious allergic reactions: hives, difficulty breathing, swelling in your face or throat
- Unusual bleeding or bruising; blood in urine/stools; coughing up blood
- Signs of a serious blood clot: chest pain, sudden severe headache, slurred speech, problems with vision or balance;
- Low red blood cell count (anemia): pale skin, unusual tiredness.
- Symptoms related to low levels of platelets in the blood - easy bruising, unusual bleeding (nosebleeds), purple or red spots under the skin
On the other hand with Eliquis:
- More common and potentially dangerous is its ability to cause significant bleeding that may be fatal if not treated quickly. This includes gastrointestinal bleeds and brain hemorrhages.
If you notice any signs of these conditions while on either medication immediately seek medical attention.
What are the most common side effects for Eliquis?
Eliquis, a commonly used anticoagulant, may cause the following side effects:
- Nausea or vomiting
- Minor bleeding such as nosebleeds or heavy menstrual periods
- Bruising more easily than normal
- Dizziness or feeling weak and tired
- Mild skin rash or itching
- Abdominal discomfort or pain
In rare cases, Eliquis can also result in serious bleeding events. Contact your healthcare provider immediately if you experience severe headache, dizziness, weakness, blood in urine or stools, red pinpoint spots under your skin. Always take Eliquis exactly as prescribed by your doctor to minimize these risks.
Are there any potential serious side effects for Eliquis?
While Eliquis is an effective medication for preventing blood clots and strokes, it may occasionally cause severe side effects. It's important to watch out for the following symptoms:
- Signs of a serious allergic reaction such as difficulty breathing or swallowing; swelling in your face, lips, tongue or throat; hives, itching or rash.
- Unusual bleeding including nosebleeds, bleeding gums when brushing teeth, heavy menstrual periods or abnormal vaginal bleeding
- Blood in urine (red or brown-colored urine)
- Dark tarry stools
- Coughing up blood or vomit resembling coffee grounds
- Sudden severe headache, confusion and dizziness which could be signs of hemorrhagic stroke.
If you experience any of these symptoms while taking Eliquis, seek immediate medical attention.
Contraindications for Lovenox and Eliquis?
Both Lovenox and Eliquis, like all anticoagulant medications, may increase the risk of serious bleeding complications. If you notice unusual bruising or bleeding that does not stop on its own, contact your healthcare provider immediately.
Neither Lovenox nor Eliquis should be taken if you are actively experiencing major bleeding or have a history of certain medical conditions such as active ulcers or recent brain surgery. Always inform your physician about any medication you're currently taking; certain drugs like aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), and other blood thinners can interact with these anticoagulants increasing the risk of harmful effects.
In addition, both Lovenox and Eliquis require careful monitoring in patients with kidney disease due to potential changes in drug clearance from the body. These medications must also be used cautiously during pregnancy under a doctor's guidance due to potentially increased risks for both mother and baby.
How much do Lovenox and Eliquis cost?
For the brand name versions of these drugs:
- The price of 10 syringes of Lovenox (40 mg/ml) averages around $350, which works out to about $35 per day.
- The price for a one-month supply (60 tablets) of Eliquis (5mg) is approximately $470, working out to roughly $15.66/day.
Thus, if you are on a standard dose for each drug (i.e., once daily injection for Lovenox or twice-daily tablet for Eliquis), then brand-name Eliquis is less expensive on a per-day treatment basis. However, cost should not be your primary consideration when determining which anticoagulant medication is right for you.
As it stands now:
- Enoxaparin sodium (generic version of Lovenox) still has fairly high costs due to limited competition in the market. For 10 syringes at 40 mg/ml dosage, prices can range from $100 –$300 depending upon pharmacy and location.
- Apixaban currently does not have an available generic alternative in many places and as such keeps its higher pricing similar to that of branded Eliquis.
Remember: Always consult with your healthcare provider regarding what medication would be most appropriate considering your health condition(s), lifestyle factors and financial situation.
Popularity of Lovenox and Eliquis
Enoxaparin, which is also known by the brand name Lovenox, was prescribed to around 3.3 million people in the USA in 2020. Enoxaparin accounted for about 8% of anticoagulant prescriptions in the US. This low-molecular-weight heparin has been a staple tool in preventing and treating deep vein thrombosis (DVT) and pulmonary embolism (PE). It requires subcutaneous injections which can be inconvenient for some patients.
Apixaban, available under the brand name Eliquis, saw higher prescription numbers with approximately 7.1 million people receiving this medication in the USA during 2020. Apixaban represents nearly 20% of all anticoagulant prescriptions across America. As a Factor Xa inhibitor taken orally twice daily, it offers an alternative to injectable medications like enoxaparin without compromising on efficacy or safety profile.
Conclusion
Both Lovenox (enoxaparin) and Eliquis (apixaban) have established records of usage in preventing blood clots, which can lead to serious conditions like deep vein thrombosis or pulmonary embolism. Both medications are backed by numerous clinical studies indicating their efficacy compared to placebo treatments. However, the two drugs work differently: Lovenox is a low-molecular-weight heparin that primarily inhibits factor Xa and also has some effect on thrombin, while Eliquis selectively blocks factor Xa only.
Lovenox is typically administered through subcutaneous injections and often used as an acute treatment in hospital settings or for shorter-term prevention post-surgery. On the other hand, Eliquis comes in oral form and is more frequently used for long-term prevention of clotting conditions such as atrial fibrillation.
While both medicines are available in generic forms offering cost savings for patients paying out-of-pocket, it's important to note that starting any new medication may require an adjustment period before its full effects become noticeable.
Side effects between these two anticoagulants differ somewhat; common side effects with Lovenox include bleeding complications and mild local reactions at injection sites, whereas those with Eliquis could range from minor bruising to severe bleeding. For both medications, patients should seek immediate medical attention if they experience uncontrolled bleeding or signs of blood clots – such as sudden dizziness or difficulty breathing.