Plavix vs. warfarin: Uses, costs, coverage, and side effects

In this article:

• Insurance coverage and cost
• Side effects
• Interactions and warnings

In this article

• Insurance coverage and cost
• Side effects
• Interactions and warnings

Both Plavix and warfarin are blood thinners doctors or healthcare providers often prescribe after a heart attack to lower the risk of stroke or another heart attack. However, they work on different parts of the clotting process and are approved for different conditions. Plavix is the brand name for clopidogrel, which works as a P2Y12 inhibitor that blocks platelets from clumping together. On the other hand, warfarin is a generic drug and vitamin K antagonist that blocks the production of blood clotting factors. 

When comparing Plavix versus warfarin, it can be helpful to know some key differences between the two drugs, including forms, dosage, treatment plans, and who might benefit from taking the medication.

Compare Plavix vs. warfarin key differences
	Plavix	Warfarin
Drug class	Antiplatelet, platelet aggregation inhibitor, P2Y12 inhibitor	Anticoagulant, vitamin K antagonist
Brand/generic status	Brand	Generic
What is the generic name? What is the brand name?	Clopidogrel	Jantoven, Coumadin
What form(s) does the drug come in?	Tablet	Tablet
What is the standard dosage?	75 mg once per day	2 to 10 mg, once per day
How long is the typical treatment?	Varies, depending on what is being treated, but typically 12 months or more.	Varies, but typically three to six months
Who typically uses the medication?	Adults	Adults

Plavix and warfarin are both approved in the United States to help prevent blood clots, but they work differently in the body. As a result, their specific uses can vary, and they may be prescribed for different conditions, including some off-label uses.

Compare Plavix vs. warfarin conditions treated
Condition	Plavix	Warfarin
Prevention of heart attack or stroke after a recent heart attack or stroke	Yes	Yes
Prevention or treatment of venous thrombosis	Off-label	Yes
Prevention of stroke in atrial fibrillation	Off-label	Off-label
Prevention of blood clots after stent placement	Off-label	Off-label
Prevention of blood clots after cardiac valve replacement	Off-label	Yes

Is warfarin better than Plavix?

In many cases, it might not be right to say whether warfarin or Plavix is better since they’re often used for different problems. “Given that Plavix and warfarin are prescribed for such different conditions, one cannot really consider one of these two medications to be ‘better’ or more effective than the other,” explains Matthew L. Holt, Pharm.D., assistant professor of pharmacology at PCOM (Philadelphia College of Osteopathic Medicine).

For example, Plavix is approved to prevent clots and support healthy blood flow after a heart attack or ischemic stroke. Healthcare providers also prescribe it off-label with aspirin after a stent is placed in the heart. “Plavix is often prescribed after a patient has received a ‘stent’ in one of their coronary arteries, and Plavix can help prevent blood from clotting around the stent,” Dr. Holt explains.

 On the other hand, warfarin is typically prescribed to prevent or treat blood clots in conditions like venous thromboembolism, which includes deep vein thrombosis (DVT) and pulmonary embolism (PE). “These clots are not generally caused by excess platelet activation but are caused by the tendency for blood to congeal, or ‘coagulate,’ when it is either moving very slowly, or not at all, in a large vein,” Dr. Holt describes.

Some people may do better on Plavix, while others respond more effectively to warfarin. The latter needs more monitoring, but it may be the right choice depending on what’s being treated. Always consult a healthcare provider for a treatment plan that can give you the best results. 

How long does it take for Plavix and warfarin to work?

Something else to consider is that each medication has a different timeline when it comes to how quickly its therapeutic effects occur, says Joyce Oen-Hsiao, MD, an associate professor of medicine at Yale School of Medicine.

 For example, Plavix is taken once per day, and blood-thinning effects usually occur within four to 24 hours of starting the medication, according to Dr. Oen-Hsiao. But warfarin takes a little longer to thin the blood, usually not taking effect until three days after the initial dose, Dr. Oen-Hsiao says. If you’re taking warfarin, sometimes you need to be put on another blood thinner like heparin or enoxaparin when you first start taking warfarin, until the warfarin begins to take full effect, she adds.

Plavix vs. warfarin: Insurance coverage and cost comparison 

If you’re wondering about insurance coverage for Plavix or warfarin, there’s good news.

 “Most insurances, including Medicare and Medicaid, cover antiplatelet agents such as Plavix and anticoagulants such as warfarin,” says Hmoud Hosam, MD, a cardiologist fellow at Northwell’s Lenox Hill Hospital. “Because warfarin has been available for decades, it’s known to be a cheap and economical alternative should a patient have difficulty affording newer anticoagulant agents.” Of course, insurance coverage isn’t guaranteed, and there may be copayments or coinsurance payments that have to be met, depending on your insurance plan. 

 Plavix and warfarin are both available as generic medications, which makes them both relatively accessible. Without insurance, Plavix usually costs about $640 for a 30-day supply of 75 mg tablets. With a SingleCare savings card, the price can drop to $4 for 30, 75 mg tablets of generic Plavix.

 Buying warfarin without insurance usually costs approximately $27 for 30, 5 mg tablets. However, with a SingleCare savings card, the price can be lowered to about $4 for 30, 5 mg tablets of warfarin. 

Compare Plavix vs. Warfarin cost and coverage
	Plavix	Warfarin
Typically covered by insurance?	Yes (generic)	Yes
Typically covered by Medicare Part D?	Yes (generic)	Yes
Typically covered by Medicaid?	Usually, but may vary by state Medicaid regulations	Usually, but may vary by state Medicaid regulations
Quantity	30, 75 mg tablets	30, 5 mg tablets
SingleCare cost	$4	$4

Warfarin vs. Plavix side effects

Warfarin and Plavix have possible side effects, some of which can overlap. Because they’re blood thinners, both drugs carry a significant risk of severe bleeding, which may need immediate medical attention. People who take warfarin also need regular visits and follow-up checks to ensure it works well without causing bleeding.

“The biggest side effect, or better termed adverse effect, is bleeding, which can sometimes be very dangerous,” says Mohanakrishnan Sathyamoorthy, MD, professor and chair of internal medicine at Burnett School of Medicine at TCU. His recommendation? “Taking fall risk precautions or being cautious with activities that could predispose one to falls is crucial,” Dr. Sathyamoorthy says.

However, even for bleeding, the medications can differ in terms of risk. “Warfarin carries a higher risk of bleeding than Plavix, and, additionally, warfarin therapy has to be monitored by way of finger sticks or occasional blood draws to ensure that the risk of bleeding is not dangerously high,” Dr. Holt says.

Besides an increased risk of bleeding, other warfarin side effects include nausea, vomiting, bloating, stomach pain, gas, and changes to your sense of taste. In addition to bleeding, Plavix may also cause other side effects, including itching, diarrhea, stomach pain, and indigestion.

Plavix and warfarin drug interactions and warnings

As blood thinners, Plavix and warfarin can interact with other drugs that have blood-thinning effects. These include other anticoagulants, antiplatelet medications, nonsteroidal anti-inflammatory drugs (NSAIDs), and some antidepressants, such as selective serotonin reuptake inhibitors (SSRIs).

When it comes to Plavix interactions, certain medications may decrease the effectiveness of Plavix, including proton pump inhibitors (PPIs) and calcium channel blockers (CCBs). However, warfarin generally has more drug interactions than Plavix. For example, warfarin can interact with various antibiotics, antifungal drugs, herbal supplements, and other products that can either increase the risk of bleeding or make warfarin less effective at preventing clots.

Since the benefits of taking warfarin or Plavix generally outweigh the risks, there are very few groups of people who should avoid taking these medications if they’re needed, Dr. Holt says. Both Plavix and warfarin shouldn’t be taken if you are pregnant, and you should ask your provider about the safety of these medications while breastfeeding. Additionally, “patients with a low platelet count at baseline should either avoid these medications or be monitored by their physician meticulously,” Dr. Hold advises.

Plavix and warfarin food interactions

While Plavix doesn’t generally have food restrictions, warfarin can interact poorly with foods that you may be eating. “Warfarin interacts with foods high in vitamin K, especially green, leafy vegetables, such as kale, spinach, mustard greens, asparagus, and broccoli,” Dr. Oen-Hsiao says. But this doesn’t mean you have to avoid these foods entirely.

“In the past, patients were told to avoid all green leafy vegetables; however, now we encourage patients to be consistent with how many vegetables they eat weekly,” Dr. Oen-Hsiao explains. Sometimes, the warfarin dosage is adjusted based on your dietary pattern, Dr. Oen-Hsiao adds. 

We all have different health issues and specific patient needs. The best way to manage them is to consult a healthcare provider who can explore different options and find the right blood thinner for you.