Eliquis vs. aspirin: Differences & similarities explained

Eliquis (apixaban) and aspirin are both oral drugs that decrease blood clotting, but that is where their similarities end. They thin the blood by very different mechanisms and are used for different medical conditions. How effective one is versus the other depends on the condition being treated. And their side effects and costs are quite different. We’ll compare and contrast Eliquis and aspirin so you better understand why your healthcare provider may recommend one over the other.

Eliquis vs. aspirin: Key differences

Eliquis is an anticoagulant, a powerful blood thinner that acts by inhibiting factor Xa, one link in a chain of enzymes responsible for blood clotting. In comparison, aspirin inhibits the enzyme cyclooxygenase, which thereby leads to less platelet aggregation or blood clotting. Aspirin therapy has a long-lasting effect and requires only once-daily dosing, compared to Eliquis needing twice-daily dosing due to wearing off quicker. Both drugs are used by adults for time frames that can range from months to years, sometimes even being lifelong treatments.

Eliquis vs. aspirin: Conditions treated

The two drugs’ distinct mechanisms lend themselves to different uses. Eliquis is often tasked with treating blood clots that form in the heart or leg veins and travel elsewhere, such as the brain. If a clot travels to the brain, it can cause an embolic stroke. If it travels to the lungs, it can cause pulmonary embolism. In the common heart condition atrial fibrillation, clots can form in the atrium, or upper chamber of the heart, and travel to organs like the brain.

Conversely, aspirin use is typically directed toward blockages inside arteries to the brain or heart to treat resultant thrombotic strokes or heart attacks, as well as to prevent recurrent episodes.

Is Eliquis better than aspirin?

The question of whether Eliquis is better than aspirin is certainly a loaded one. Truly, it depends on the situation, including the particulars of the medical condition being treated and the individual patient needing therapy. For example, studies have shown aspirin to be ineffective in preventing strokes in those with atrial fibrillation (Afib). In contrast, Eliquis has been found to be superior in these circumstances, even when compared to warfarin, the vitamin K antagonist anticoagulant.

However, aspirin would typically be chosen over Eliquis for myocardial infarction or heart attack. Your healthcare provider’s medical advice will be paramount when choosing between aspirin and Eliquis.

Eliquis vs. aspirin: Insurance coverage and cost comparison

Eliquis and aspirin are at opposite ends of the drug price spectrum. As a brand-name product, Eliquis carries a higher price than generic aspirin. However, because Eliquis is a prescription drug and aspirin is available without a prescription, Eliquis may be better covered by insurance plans and Medicare. Check with your drug formulary for details.

Regardless, there will be an opportunity to save by using an Eliquis coupon or an aspirin coupon from SingleCare. The coupon can bring the price of 60, 5 mg Eliquis tablets down for $800 to $479, depending on one’s pharmacy. For aspirin, you could pay as little as $1 instead of $11 for 90 chewable tablets. Showing your SingleCare prescription discount card to your pharmacist is a reliable way to save on drug costs, particularly if you don’t have health insurance or if you have high insurance copays or deductibles.

Eliquis vs. aspirin: Side effects

Bleeding is the side effect most feared when using any variety of blood thinner, including both Eliquis and aspirin. That includes minor bleeding and bruising, as well as major bleeding in the cranium or intestinal tract. The degree of risk of these bleeding events is dependent on an individual’s risk factors such as age and frequency of falls. Ask your healthcare provider to discuss your specific risks and benefits when taking either of these drugs.

Other than bleeding, rash and allergic reactions can occur but are less common with Eliquis than with aspirin, which can be associated with allergic reactions in 1%–2% of the general population but up to 26% of those with asthma or chronic rhinosinusitis. The rare but highly fatal condition Reye’s Syndrome has been attributed to aspirin use by children in the setting of viral upper respiratory infection. Other side effects can occur as well with Eliquis and aspirin, so it is best to ask your healthcare provider or pharmacist for a complete listing.

Sources: DailyMed Eliquis drug label, StatPearls, and AVERROES trial.

Eliquis vs. aspirin: Drug interactions

Since bleeding events are the biggest risks of Eliquis and aspirin, drug interactions that can compound that risk are a significant concern. Combining either drug with another blood thinner, including each other, may be recommended by a healthcare professional, but only after careful consideration. Problems can arise with nonsteroidal anti-inflammatory drugs (NSAIDs), which are widely available over the counter and could increase the risk of bleeding (particularly stomach bleeding) when taken with any blood thinner. Besides medications, alcohol use can be an issue with Eliquis and aspirin due to stomach bleeding and fall risk.

Eliquis is metabolized primarily by the liver’s CYP3A4 enzyme system. Consequently, drugs that inhibit that enzyme can raise Eliquis levels and risks, while drugs that stimulate the enzymes can drop Eliquis levels and benefits. Various prescription and over-the-counter medicines, as well as grapefruit juice, affect the CYP3A4 enzyme. While the following table highlights some notable interactions, many more exist and can be reviewed with your healthcare team.

Aspirin vs. Eliquis: Drug warnings

The Food and Drug Administration (FDA) has a host of warnings on the labels of aspirin and Eliquis. Primarily, they relate to bleeding risk. There’s a risk of spinal hematoma or bleeding after spinal procedures when taking Eliquis. Heightened bleeding risks with aspirin are possible among patients who are older than 60, take NSAIDs, have had stomach ulcers, drink alcohol, or take steroids.

There’s also a warning about Reye’s syndrome and allergic reactions while taking aspirin. You should also avoid taking it during pregnancy—at 20 weeks of gestation or later.

Eliquis has an additional warning about its tendency to wear off quickly with discontinuation, which can prompt a time frame of elevated blood clot risk. The FDA warns that Eliquis is not recommended for those with prosthetic heart valves, antiphospholipid antibody syndrome, or requiring thrombolysis or embolectomy for pulmonary embolism. Its use in pregnancy is still being investigated.

Bottom line

Besides both being oral medications that thin the blood when needed (and run the risk of bleeding as a result), Eliquis and aspirin have many differences. Their utility, side effects, drug interactions, and FDA warnings are distinct. The lower price of aspirin may seem appealing, but switching from Eliquis to aspirin could put a patient at risk of blood clots or stroke. Deciding which drug is best suited to the situation is complex and requires the advice of your healthcare team, including primary care providers, specialists like cardiologists or neurologists, and pharmacists.