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Key takeaways
Eliquis is a convenient oral alternative to Lovenox that eliminates the need for self-injections.
While both drugs prevent blood clots, Eliquis directly inhibits Factor Xa, while Lovenox enhances antithrombin III to reduce clot formation.
The transition from Lovenox to Eliquis is typically seamless and timed with the next scheduled Lovenox dose to avoid gaps in treatment.
If you’re taking Lovenox (enoxaparin) for blood thinning, you might be experiencing some common issues like bruising, pain at the injection sites, or just feeling frustrated with having to give yourself daily shots. Eliquis offers the convenience of oral tablets instead of injections for those looking for a different option than Lovenox. It works differently from Lovenox but is used for the same purpose of preventing dangerous blood clots.
Switching from Lovenox to Eliquis (apixaban) can be straightforward when done under proper medical supervision. Typically, you would start the first dose of Eliquis when the next scheduled dose of Lovenox is due. However, timing is important when switching medications to make sure treatment is effective without increasing bleeding risks.
How do these medications work?
Lovenox is a type of low molecular weight heparin (LMWH), a parenteral anticoagulant given by injection under the skin once or twice daily. It increases the activity of antithrombin III, a natural protein that inactivates clotting factors. This protein mainly targets Factor Xa and thrombin to prevent blood clots from forming.
Eliquis belongs to a newer class of medications called direct oral anticoagulants (DOACs) or novel oral anticoagulants (NOACs), which includes drugs like Xarelto (rivaroxaban), Pradaxa (dabigatran), and Savaysa (edoxaban). Eliquis works by directly blocking Factor Xa, a key enzyme in the blood clotting process, to prevent the formation of blood clots. Unlike Lovenox, Eliquis is taken by mouth twice daily.
Both medications are anticoagulants or blood thinners that prevent and treat venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE). However, they have different pharmacokinetics and work in slightly different ways. While Lovenox indirectly inhibits Factor Xa through antithrombin, Eliquis directly blocks Factor Xa. Another key difference is in how they’re given—Lovenox requires injections, while Eliquis is a pill.
What are the benefits of switching from Lovenox to Eliquis?
Switching from Lovenox to Eliquis offers several advantages for patients who need blood thinners. The change can make treatment easier while maintaining or improving effectiveness.
Convenience of oral dosing
Eliquis is a pill that patients take by mouth, which may be much easier to administer than Lovenox injections. Some patients find these injections uncomfortable and difficult to use, sometimes requiring help from family members or healthcare providers.
Eliquis only requires taking a pill twice daily, which could make it easier to take at home, less painful, and simpler to maintain a consistent schedule. Studies show that patients typically report higher satisfaction with oral medications compared to injections, which can improve how well they stick to their treatment plan.
No need to change the dose for kidney problems
Unlike Lovenox, Eliquis usually doesn’t require major dose adjustments for people with mild to moderate kidney problems. Lovenox is primarily cleared through the kidneys. Therefore, people with impaired renal function often need dose adjustments, especially if they have a low creatinine clearance (CrCl).
Eliquis works differently. This DOAC is removed from the body in multiple ways, not just through the kidneys, which could mean:
- Fewer blood tests to monitor kidney function
- More stable dosing for many patients
- Less risk of drug accumulation in kidney disease
Healthcare providers still need to be careful with both medications for patients with severe kidney disease, but Eliquis generally requires fewer adjustments for kidney problems.
Similar efficacy and safety
Research shows that Eliquis is at least as effective as Lovenox for preventing blood clots. Studies comparing the medications show that Eliquis is highly effective for preventing deep vein thrombosis and pulmonary embolism, which Lovenox also treats.
In a study involving 100 patients who had weight loss surgery, groups taking Eliquis and Lovenox had no cases of blood clots after surgery, and only 2% of patients in each group experienced bleeding. Another study comparing these drugs in patients undergoing knee replacement surgery showed that only 1.5% of 200 people taking Eliquis or Lovenox developed blood clots, suggesting comparable efficacy.
No risk of heparin-induced thrombocytopenia
Another potential advantage of switching to Eliquis is eliminating the risk of heparin-induced thrombocytopenia (HIT), a dangerous immune reaction that causes low platelet counts and increased risk of life-threatening blood clots. Lovenox, like unfractionated heparin (UFH) and other LMWHs like Fragmin (dalteparin), carries a small but serious risk of HIT.
Eliquis works through a completely different mechanism than heparin-based products. Its direct Factor Xa inhibition means it doesn’t interact with platelets like heparin does. For patients who have experienced HIT in the past or are at higher risk, switching to Eliquis removes this concern entirely.
Lovenox vs. Eliquis comparison chart |
||
|---|---|---|
| Lovenox | Eliquis | |
| Standard adult dosage | 40 mg once daily or 30 mg every 12 hours | 5 mg twice daily |
| Rate of major blood clots | 1.2% | 0.6% |
| All-cause mortality | 0.09% | 0.2% |
| Odds ratio for major bleeding | 1.00 | 0.55 |
| Covered by insurance? | Yes | Yes |
| Average retail cost for a 30-day supply of brand-name drug* | $242 for brand-name Lovenox | $809 for brand-name Eliquis |
| SingleCare cost for a 30-day supply* | $42 for generic enoxaparin sodium | $488 for brand-name Eliquis (no generic version available) |
*Cost at the time of publication. Drug prices fluctuate and vary by pharmacy.
How to switch from Lovenox to Eliquis
Switching from Lovenox to Eliquis is a relatively simple process. No tapering or gradual reduction of the dosage of Lovenox is needed when switching between these medications. After the discontinuation of Lovenox, you can start Eliquis at the time the next dose of Lovenox would be due.
For example, if you normally take Lovenox at 8 a.m., you would take your last dose as scheduled, then start Eliquis at 8 a.m. the following day instead of the next Lovenox dose. The standard starting dose of Eliquis is typically 5 mg twice daily, but this may vary based on different factors.
Lovenox to Eliquis dosage conversion |
||
|---|---|---|
| Use | Lovenox dosage | Eliquis dosage |
| Prevention or prophylaxis of DVT following hip or knee replacement surgery | 40 mg once daily or 30 mg every 12 hours | 2.5 mg twice daily |
| Treatment of DVT and PE | 1 mg/kg every 12 hours or 1.5 mg/kg once a day | 10 mg twice daily for one week, then 5 mg twice daily |
Some people might need a lower dose of Eliquis (2.5 mg twice daily) if they meet at least two of these criteria:
- Age 80 years or older
- Body weight 60kg (132 lbs) or less
- Serum creatinine 1.5 mg/dL or higher
Unlike vitamin K antagonists such as warfarin, Lovenox and Eliquis do not require regular INR monitoring. This makes managing anticoagulation therapy more convenient, reducing the need for frequent blood tests.
Always talk to your healthcare provider before switching medications and follow their instructions for timing and dosage. Do not skip doses or double up if you miss a dose.
Side effects from stopping Lovenox and starting Eliquis
The side effects of Lovenox and Eliquis are similar, especially when it comes to the risk of bleeding. Therefore, you’ll want to keep in mind the possibility of potential side effects when switching to Eliquis.
Side effects of Eliquis that may occur include:
- Bleeding complications, such as unusual bruising and prolonged bleeding from cuts
- Headache
- Dizziness
- Nausea
- Elevated liver enzymes
- Allergic reactions, with symptoms such as swelling or difficulty breathing
In rare cases, serious bleeding may occur. Seek immediate medical attention if you experience signs of serious bleeding, such as blood in your urine or stool, vomiting blood or material that looks like coffee grounds, and unexplained bruising or bleeding that doesn’t stop. If you notice any of these symptoms, it’s important to contact a healthcare professional right away.
In addition, Eliquis comes with drug interactions that Lovenox doesn’t have. Medications that can interact with Eliquis include:
- Strong CYP3A4 inhibitors: Certain medications like ketoconazole and ritonavir can increase the levels of Eliquis in your body, which may increase the risk of bleeding.
- Strong CYP3A4 inducers: Certain drugs, such as rifampin and carbamazepine, can lower the effectiveness of Eliquis, which might lead to a higher chance of blood clots.
- Other anticoagulants or antiplatelet agents: Taking other blood thinners or medications that prevent blood clots, like warfarin or aspirin, along with Eliquis can significantly increase the risk of serious bleeding.
Tell your healthcare provider about any prescription drugs, over-the-counter medications, or herbal supplements you take before starting a blood thinner.
How to minimize Eliquis side effects
It’s possible to reduce the risk of bleeding and other side effects from Factor Xa inhibitors like Eliquis. Consider the following when switching to Eliquis:
- Take Eliquis as prescribed by your healthcare provider.
- Stay well hydrated and avoid excessive alcohol consumption, which may worsen side effects.
- Monitor your liver function periodically while taking Eliquis, as it can sometimes cause elevated liver enzymes.
- Avoid taking other medications that increase bleeding risk, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen, unless directed by your healthcare provider.
- Carry a medication list or wear a medical alert bracelet indicating you are on a blood thinner in case of emergency.
Can you take Eliquis and Lovenox together?
Eliquis and Lovenox should not be taken together since both are anticoagulants that work to prevent blood clots. Using them at the same time can significantly increase your risk of bleeding.
Talk to your prescribing healthcare provider about switching between Lovenox and Eliquis. They can provide medical advice and guidance based on your medical history and current health condition. Never attempt to change your anticoagulation therapy on your own, as improper transitions between these medications may cause serious complications.
- What are the reasons for patient preference? A comparison between oral and subcutaneous administration, PubMed (2012)
- Lovenox highlights of prescribing information, Food and Drug Administration (2021)
- Comparison between low molecular weight heparin and apixaban (direct oral anticoagulant) in the prophylaxis against venous thromboembolism after laparoscopic sleeve gastrectomy, Obesity Surgery (2025)
- Effectiveness of apixaban versus enoxaparin in preventing wound complications and deep venous thrombosis following total knee replacement surgery: A retrospective study, International Journal of Clinical Practice (2021)
- Apixaban versus enoxaparin in patients with total knee arthroplasty. A meta-analysis of randomised trials, Thrombosis and Haemostasis (2011)
- Eliquis highlights of prescribing information, Food and Drug Administration (2021)