From the Guidelines
Eliquis (apixaban) is generally preferred over Pradaxa (dabigatran) due to its better safety profile and lower risk of major bleeding complications, as demonstrated in studies such as the one published in Stroke 1. When comparing the two medications, it's essential to consider their dosing, mechanism of action, and potential side effects. Eliquis is typically dosed at 5mg twice daily, while Pradaxa is usually given as 150mg twice daily.
- Key differences between Eliquis and Pradaxa include:
- Mechanism of action: Eliquis inhibits factor Xa, while Pradaxa directly inhibits thrombin
- Bleeding risk: Eliquis has a lower risk of major bleeding complications, particularly gastrointestinal bleeding, compared to Pradaxa 1
- Monitoring requirements: Eliquis requires less frequent monitoring of kidney function compared to Pradaxa
- Drug interactions: Eliquis has fewer drug interactions than Pradaxa The study published in Stroke 1 compared the key studies of new oral antithrombotics, including dabigatran and apixaban, and found that apixaban had a lower risk of major bleeding complications.
- The event rate vs comparator for apixaban was 1.3% vs 1.6% (P<0.001), with a hazard ratio of 0.79 (0.66-0.95) 1
- The major bleeding rate for apixaban was 2.1% vs 3.1% for warfarin, and the intracerebral hemorrhage rate was 0.2% vs 0.5% for warfarin 1 Overall, while both medications are effective anticoagulants, Eliquis (apixaban) is generally preferred due to its better safety profile and lower risk of major bleeding complications.
From the Research
Comparison of Pradaxa (Dabigatran) and Eliquis (Apixaban)
- Pradaxa and Eliquis are both anticoagulants used to prevent stroke and systemic embolism in patients with atrial fibrillation.
- According to a study published in 2014 2, apixaban (Eliquis) has been shown to be effective in preventing stroke and systemic embolism, with a lower incidence of major bleeding events compared to warfarin.
- Another study published in 2013 3 found that apixaban was associated with a significantly lower risk of stroke or systemic embolism compared to aspirin, without an increase in the risk of major bleeding.
Efficacy and Safety
- A study published in 2016 4 found that the 5 mg twice daily dose of apixaban was safe and efficacious for patients with atrial fibrillation, including those with advanced age, low body weight, or renal dysfunction.
- The study also found that patients with atrial fibrillation and isolated advanced age, low body weight, or renal dysfunction had a higher risk of stroke or systemic embolism and major bleeding, but showed consistent benefits with apixaban compared to warfarin.
- A practical guide published in 2019 5 recommends the use of dabigatran 150 mg twice daily for patients with atrial fibrillation who have a high risk of embolism and a low risk of bleeding, while apixaban 5 mg twice daily is recommended for most other patients.
Blood Pressure Control
- A study published in 2015 6 found that high blood pressure measurement at any point during the trial was independently associated with a substantially higher risk of stroke or systemic embolism in patients with atrial fibrillation.
- The study also found that the benefit of apixaban versus warfarin on preventing stroke or systemic embolism was consistent among patients with and without a history of hypertension, and among patients with and without blood pressure control at baseline and during the trial.