Aspirin vs. Eliquis (apixaban)

• Aspirin and Eliquis (apixaban) are anticoagulants used to prevent blood clots (antithrombotics).
• Aspirin is also used to treat fever, pain, and inflammation in the body.
• Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) and Eliquis is an anticoagulant (blood thinner).
• Brand names for aspirin include Bayer Aspirin, Ecotrin, and E.C. Prin.
• Aspirin is available over-the-counter (OTC) and as a generic.
• Side effects of aspirin and Eliquis that are similar include gastrointestinal bleeding and rash.
• Side effects of aspirin that are different from Eliquis include abdominal pain, abdominal burning, cramping, gastritis, stomach ulcers, nausea, ringing in the ears, dizziness, liver toxicity, kidney impairment, and spinning sensation (vertigo).
• Side effects of Eliquis that are different from aspirin including bleeding in the brain and eyes.

Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) used to treat fever, pain, and inflammation. Aspirin is also used to prevent blood clots (antithrombotic). Other NSAIDs include ibuprofen (Motrin), indomethacin (Indocin), and nabumetone (Relafen). NSAIDs reduce levels of prostaglandins, chemicals released when there is inflammation that causes pain and fever. NSAIDs block the enzyme that makes prostaglandins (cyclooxygenase), resulting in lower levels of prostaglandins, and a reduction of inflammation, pain, and fever. Suppression of prostaglandins also reduces the function of platelets and the blood’s ability to clot. Aspirin inhibits the function of platelets for prolonged periods of time so it is used to reduce the risk of another heart attack or stroke in people who have already had a heart attack or stroke.

Eliquis (apixaban) is an anticoagulant (blood thinner) used for reducing the risk of blood clots in the heart and strokes in patients with atrial fibrillation who have no problems with their heart valves (nonvalvular atrial fibrillation). Eliquis is also used to treat and prevent deep vein thrombosis (DVT) and pulmonary embolism (PE) in patients who have undergone hip or knee replacement surgery.

Aspirin

Most patients benefit from aspirin and other NSAIDs with few side effects. However, serious side effects can occur and generally tend to be dose-related. Therefore, it is advisable to use the lowest effective dose to minimize side effects.

The most common side effects of aspirin involve the gastrointestinal system and ringing in the ears.

Gastrointestinal side effects are

• ulcerations,
• abdominal burning,
• pain,
• cramping,
• nausea,
• gastritis, and
• even serious gastrointestinal bleeding and
• liver toxicity.

Sometimes, ulceration and bleeding can occur without any abdominal pain. Black tarry stools, weakness, and dizziness upon standing may be the only signs of internal bleeding.

Ringing in the ears

• Should ringing in the ears occur, the daily dose should be reduced.

Other side effects include:

• Rash,
• kidney impairment,
• vertigo, and
• dizziness.

Other side effects and adverse reactions

• Aspirin should be avoided by patients with peptic ulcer disease or poor kidney function, since this medication can aggravate both conditions.
• Aspirin may exacerbate asthma.
• Aspirin can raise the blood uric acid level and is avoided in patients with hyperuricemia and gout.
• Children and teenagers should avoid aspirin for symptoms of the flu or chickenpox because of the associated risk of Reye's Syndrome, a serious disease of the liver and nervous system that can lead to coma and death.
• Aspirin can increase the effect of medicines used to treat diabetes mellitus, resulting in abnormally low blood sugars if blood sugar levels are not monitored.
• NSAIDs should be discontinued prior to elective surgery because of a mild tendency to interfere with blood clotting. Aspirin, because of its prolonged effect on platelets, is best discontinued at least ten to fourteen days in advance of the procedure.

Eliquis

The most common side effects of apixaban involve bleeding in the:

• stomach,
• intestines,
• brain, and
• eyes.

Bleeding due to apixaban may be fatal.

Major bleeding events were fewer in patients who received apixaban when compared to a similar group that received warfarin (Coumadin, Jantoven), another widely used drug for preventing blood clots.

Rash and serious allergic reactions also may occur.

Aspirin

Aspirin should be taken with food. Doses range from 50 mg to 6000 mg daily depending on the use.

• Usual doses for mild to moderate pain are 350 or 650 mg every 4 hours or 500 mg every 6 hours.
• Doses for rheumatoid arthritis include 500 mg every 4-6 hours; 650 mg every 4 hours; 1000 mg every 4-6 hours; 1950 mg twice daily.
• Heart attacks are prevented with 75, 81, 162 or 325 mg daily.
• 160 to 325 mg of non-enteric coated aspirin should be chewed immediately when experiencing symptoms of a heart attack.
• The dose for preventing another stroke is 75 to 100 mg daily.

Eliquis

• The usual dose in nonvalvular atrial fibrillation is 5 mg by mouth twice daily. For individuals 80 years or older, weighing less than or equal to 60 kg, or with reduced kidney function, the usual dose is 2.5 mg twice daily.
• The recommended dose for treating DVT or pulmonary embolism is 10 mg twice daily for the first 7 days and then 5 mg twice daily. After six months of treatment, the dose may be reduced to 2.5 mg daily for prevention of DVT or pulmonary embolism.
• When apixaban is used to prevent the risk of DVT after hip or knee replacement surgery, the suggested dose is 2.5 mg daily beginning 12 to 24 hours after the surgery is completed.

Aspirin

• Aspirin is associated with several suspected or probable interactions that affect the action of other drugs. The following examples are the most common of the suspected interactions.
• NSAIDs may increase the blood levels of lithium (Eskalith, Lithobid) by reducing the excretion of lithium by the kidneys. Increased levels of lithium may lead to lithium toxicity.
• Aspirin may reduce the blood pressure lowering effects of blood pressure medications. This may occur because prostaglandins have a role in the regulation of blood pressure.
• When aspirin is used in combination with methotrexate (Rheumatrex, Trexall) or aminoglycoside antibiotics (for example, gentamicin) the blood levels of the methotrexate or aminoglycoside may increase, presumably because their elimination from the body is reduced. This may lead to more methotrexate or aminoglycoside-related side effects.
• Individuals taking oral blood thinners or anticoagulants, for example, warfarin, (Coumadin) should avoid aspirin because aspirin also thins the blood, and excessive blood thinning may lead to serious bleeding.

Eliquis

• Apixaban is a substrate of both CYP3A4 and P-gp. Inhibitors of CYP3A4 and P-gp increase exposure to apixaban and increase the risk of bleeding. Inducers of CYP3A4 and P-gp decrease exposure to apixaban and increase the risk of stroke and other thromboembolic events.

Aspirin

• Aspirin is generally avoided during pregnancy because it may adversely affect the fetus. However, low aspirin doses have been safely used for the prevention of complications of pregnancy.
• Aspirin is excreted into breast milk and may cause adverse effects in the infant.

Eliquis

• There are no adequate studies in pregnant women. Use during pregnancy may increase the risk of bleeding during pregnancy and delivery. Apixaban should be avoided during pregnancy.
• It is not known if apixaban is excreted in human milk. Nursing mothers should discontinue apixaban or discontinue nursing.