Which blood thinner is better, Eliquis or Plavix?

October 11, 2025 •

2 min read

Patients with atrial fibrillation (AFib) have a five-fold increased risk of stroke. This raises the question for many: which blood thinner is better, Eliquis or Plavix? While both are vital, they are not interchangeable and serve different clinical needs.

Quick Summary

Eliquis (apixaban) is an anticoagulant that inhibits a clotting protein, while Plavix (clopidogrel) is an antiplatelet that stops platelets from clumping. The choice depends on the specific condition being treated, such as AFib or recent heart attack.

Key Points

Different Mechanisms: Eliquis is an anticoagulant that blocks a clotting protein (Factor Xa), while Plavix is an antiplatelet that stops platelets from clumping.
Distinct Uses: Eliquis is mainly used for atrial fibrillation (AFib) and DVT/PE, whereas Plavix is used after a heart attack, stroke, or for peripheral artery disease.
Dosage Frequency: Eliquis is typically taken twice a day, while Plavix is a once-daily medication.
Reversibility: The effects of Eliquis can be reversed with a specific antidote (Andexxa), but Plavix has no direct reversal agent.
Cost and Availability: Plavix is widely available as a low-cost generic (clopidogrel), while Eliquis is primarily a more expensive brand-name drug.

Understanding Blood Thinners: Eliquis and Plavix

Eliquis (apixaban) and Plavix (clopidogrel) are common prescription medications referred to as blood thinners, but they belong to different drug classes and function differently. The decision of which to use depends on the specific medical condition being treated. Eliquis is an anticoagulant, while Plavix is an antiplatelet agent.

Mechanism of Action: Anticoagulant vs. Antiplatelet

Eliquis and Plavix prevent blood clots through different mechanisms.

Eliquis (Apixaban): Eliquis is a direct oral anticoagulant (DOAC) that inhibits Factor Xa, an enzyme involved in blood clot formation. This reduces the production of thrombin, a protein essential for clotting. Eliquis does not directly affect platelets.

Plavix (Clopidogrel): Plavix is an antiplatelet medication. It prevents platelets from aggregating (sticking together) by blocking specific receptors on their surface. This effect lasts for the lifespan of the affected platelets, typically 7 to 10 days. Plavix is a prodrug, meaning it needs to be converted by the liver enzyme CYP2C19 to its active form.

Approved Uses and Primary Indications

Eliquis and Plavix are approved for different conditions.

Eliquis is primarily indicated for:

Reducing stroke risk in nonvalvular atrial fibrillation (AFib).
Treating deep vein thrombosis (DVT) and pulmonary embolism (PE).
Preventing DVT/PE after hip or knee replacement surgery.

Plavix is primarily indicated for:

Preventing clots after a heart attack or stroke.
Treating acute coronary syndrome (ACS).
Preventing clots in peripheral arterial disease (PAD).

A doctor may prescribe both medications together in certain high-risk cases.

Side Effects and Safety Profile

The main risk for both medications is bleeding, ranging from bruising to serious internal bleeding.

Black Box Warnings:

Eliquis: Warnings include increased clot risk if stopped prematurely and spinal clot risk with certain procedures.
Plavix: Warning about reduced effectiveness in patients who are poor metabolizers of the drug due to genetic variations affecting the CYP2C19 enzyme.

Reversibility: Eliquis's effects can be reversed in emergencies with Andexxa. Plavix has no direct reversal agent, but platelet transfusion may be used for severe bleeding.

Comparison Table: Eliquis vs. Plavix


Feature	Eliquis (Apixaban)	Plavix (Clopidogrel)
Drug Class	Anticoagulant (Factor Xa Inhibitor)	Antiplatelet (P2Y12 Inhibitor)
Mechanism	Inhibits the Factor Xa protein.	Prevents platelets from clumping.
Primary Uses	Stroke prevention in AFib, treating/preventing DVT & PE.	Preventing heart attack/stroke after a previous event, ACS, PAD.
Dosage	Typically twice daily.	Typically once daily.
Reversal Agent	Yes, Andexxa.	No direct reversal agent.
Generic Available	Approved, but limited availability expected until 2026.	Yes, widely available.
Cost	Generally more expensive.	Generic clopidogrel is cheaper.

Conclusion

Eliquis and Plavix are not interchangeable; they are used for different conditions. The best choice depends on a patient's specific diagnosis, history, genetics, and risk factors. Eliquis is often used for AFib stroke prevention, while Plavix is key after a heart attack or for PAD. Consult a healthcare provider to determine the most appropriate medication.

For more information on the use of anticoagulants, you can visit the National Blood Clot Alliance.

Frequently Asked Questions

In some high-risk situations, such as in patients with both atrial fibrillation and coronary artery disease, a doctor may prescribe both Eliquis and Plavix. However, this combination significantly increases the risk of bleeding and is only done under careful medical supervision.

Eliquis and Plavix are not considered direct competitors because they are approved for different medical conditions. One is not more effective than the other overall; their effectiveness depends on the specific condition being treated, such as Eliquis for AFib-related stroke prevention or Plavix for preventing a second heart attack.

The most common and serious side effect for both medications is bleeding. This can range from minor issues like easy bruising and nosebleeds to severe, life-threatening events like gastrointestinal or brain hemorrhage.

While a generic version of Eliquis (apixaban) has been approved by the FDA, it may not be widely available to the public until at least 2026. Plavix, on the other hand, has a widely available and less expensive generic version called clopidogrel.

Brand-name Eliquis is significantly more expensive than generic Plavix (clopidogrel). The generic version of Plavix makes it a much more affordable option for many patients.

A doctor would choose Plavix for conditions where platelet aggregation is the primary concern, such as after a heart attack, stroke, or in patients with peripheral artery disease. These are the FDA-approved indications for Plavix.

A doctor would typically choose Eliquis to prevent stroke in a patient with nonvalvular atrial fibrillation or to treat or prevent deep vein thrombosis (DVT) and pulmonary embolism (PE). These are conditions where anticoagulants that work on the clotting cascade are preferred.