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Is Eliquis A Vitamin K Antagonist

Does Vitamin K2 Interfere With Blood Thinners

Eliquis vs Warfarin

Debates still linger on whether vitamin K2 acts like vitamin K1 when it comes to blood clotting and blood thinners.

We can base the argument that vitamin K2 should not be a problem of blood thinner users primarily on the following premises:

  • Vitamin K1 differs from vitamin K2 to some degrees in terms of chemical structures. The dietary sources of vitamin K2 are not the same as that of K1.

Vitamin K1 vs. vitamin K2. Source: Turck D, Bresson JL, Burlingame B, et al. EFSA Journal. Dietary reference values for vitamin K. 2017 15. doi:10.2903/j.efsa.2017.4780

  • If we assume that all types of vitamin K do have an interfering effect, we know that vitamin K only affects one class of blood thinnersthe VKAs.
  • Moreover, most blood thinners are not in the VKA class.

While the above premises sound logical, they still dont prove that vitamin K2 wont affect blood thinners at all. In fact, there are some pieces of evidence that vitamin K2 could affect VKA blood thinners .

Ranking Of Noacs For Efficacy And Safety

Table 2 demonstrated the ranking of NOACs. In NVAF patients with normal renal function, dabigatran-150 mg was the winner for the efficacy , and edoxaban-30 mg was the safest intervention . In NVAF patients with mild renal impairment, edoxaban-60 mg was the most effective treatment , and edoxaban-30 mg was the safest intervention . In NVAF patients with moderate renal impairment, dabigatran-150 mg was the most effective treatment , and edoxaban-15 mg was the safest intervention .

Table 2. SUCRA Ranking of OACs for efficacy and safety stratified by renal function.

Anticoagulation: Updated Guidelines For Outpatient Management

PATRICIA WIGLE, PharmD BRAD HEIN, PharmD and CHRISTOPHER R. BERNHEISEL, MD University of Cincinnati/The Christ Hospital, Cincinnati, Ohio

Am Fam Physician. 2019 Oct 1 100:426-434.

Vitamin K antagonists , unfractionated heparin, low-molecular-weight heparin , and direct oral anticoagulants are commonly used for the prevention and treatment of systemic embolism associated with atrial fibrillation, stroke, and venous thromboembolism . LMWH and select direct oral anticoagulants can be used for anticoagulation therapy initiation on an outpatient basis.


Compared with vitamin K antagonists, direct oral anticoagulants have fewer overall drug-drug interactions, a comparable bleeding rate, a shorter half-life, and fixed dosing based on indication, drug interactions, and renal or hepatic function.

American Academy of Family Physicians guidelines recommend the use of oral anticoagulants in patients with a CHADS2 score greater than 1 for the prevention of stroke in atrial fibrillation. The American Heart Association/American College of Cardiology/Heart Rhythm Society guidelines recommend a direct oral anticoagulant over a vitamin K antagonist, unless the patient has moderate-to-severe mitral stenosis or a mechanical heart valve.

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Conditions Treated By Eliquis And Warfarin

Eliquis is FDA approved to:

  • Lower stroke risk and systemic embolism risk in patients with nonvalvular atrial fibrillation
  • Prevent deep vein thrombosis after hip or knee replacement surgery
  • Treat DVT or pulmonary embolism
  • Lower the risk of DVT and PE recurrence

Warfarin is FDA approved to:

  • Prevent and treat DVT and PE
  • Prevent and treat complications from atrial fibrillation and/or cardiac valve replacement
  • Lower the risk of death, recurrent heart attack, and clotting events such as stroke, after a heart attack

Warfarin does not treat an established clot or reverse tissue damage. Once a clot has occurred, warfarin can be used to prevent the clot from growing and to prevent complications that can be serious or fatal.

Data Extraction Quality Evaluation And Bias Assessment


The data extracted from each study included study identifiers characteristics of individual study qualifying risk factors CHADS2 score time in therapeutic range of warfarin group renal function characteristics of drug intervention . Detailed data by renal function that was not reported in the original publications was further extracted from the US FDA databases . Quality of the study was analyzed using the Cochrane Collaboration Risk of Bias Tool, which include selection bias , information bias , and bias in the analysis . Potential publication bias was explored using visual inspection of funnel plots if the number of included studies was more than 10 .

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Scope Of The Global Anticoagulants Market Report

Anticoagulants are medicines that help prevent blood clots. Theyre given to people at a high risk of getting clots, to reduce their chances of developing serious conditions like strokes and heart attacks. A blood clot is a seal created by the blood to prevent bleeding from wounds. If a blood clot blocks the flow of blood through a vessel, the affected a part of the body will become starved of oxygen and can stop working properly. Examples of Anticoagulants include aspirin, heparin and warfarin. 5.7% of those using aspirin and warfarin experienced major bleeding events after one year, compared to 3% of these on warfarin only. Anticoagulants are used to treat and stop blood clots which will occur in blood vessels. Blood clots can block blood vessels.

Global Anticoagulants market report is segmented on the basis of drug class, route of administration, application and regional & country level. Based upon drug class Anticoagulants market is classified into NOACs, Eliquis, Bevyxxa, Xarelto, Savaysa & lixiana, Pradaxa, Heparin & LMWH, Vitamin K antagonist and others. Based upon route of administration Anticoagulants market is classified into Oral anticoagulant, Injectable anticoagulant. Based upon Application Anticoagulants market is classified into atrial fibrillation & heart attack, Stroke, Deep vein thrombosis , pulmonary embolism and others.

Nonvitamin K Antagonist Oral Anticoagulants In The Treatment Of Atrial Fibrillation

Annual Review of Medicine

Vol. 70:61-75 First published as a Review in Advance on November 26, 2018

Alexander C. Fanaroff and E. Magnus Ohman

Division of Cardiology and Duke Clinical Research Institute, Duke University, Durham, North Carolina 27710, USA email:

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What Are Vitamin K Antagonists

A vitamin K antagonist is a special blood thinner. VKAs prevent blood clots by decreasing the action of vitamin K.

Among VKAs, coumarins are the most commonly used. And among coumarins, warfarin is the most popular.

The interfering action, however, goes both ways. VKA depletes the action of vitamin K. On the other hand, vitamin K also interferes with the blood-thinning action of VKAs .

What Are The Main Differences Between Eliquis Vs Warfarin

The Journey of a patient on new oral anticoagulant therapy

Eliquis and warfarin are both anticoagulants, or blood thinners. Both drugs are approved by the U.S. Food and Drug Administration for prescription use.

Eliquis is made by Bristol-Myers Squibb. Eliquis is available in brand name only, but a generic will likely be available soon.

Warfarin is available in generic only. The brand-name product, Coumadin, was discontinued by its manufacturer in April 2020. Warfarin is made by a variety of manufacturers.

Warfarin requires routine monitoring of the international normalized ratio through blood tests, while Eliquis does not require regular INR monitoring.

The INR measures how quickly the blood clots. If the blood clots too quickly, there is a higher risk for blood clots. If the blood is clotting too slow, there is more of a risk for bleeding. The goal is to keep the INR in a therapeutic range , where the blood does not clot too fast or too slow. Based on the INRblood test results, the warfarin dose may be changed.

Eliquis vs. Warfarin
Adults sometimes used off-label in children

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Tell Your Doctor As Soon As Possible If

Tell your doctor as soon as possible if you notice any of the following:

  • excessive bleeding or prolonged bleeding. There is no antidote to reverse this bleeding. It is important to contact your doctor immediately if you experience excessive or prolonged bleeding.
  • stomach swelling, yellowing of the skin or whites of the eyes
  • oozing from your surgical wound
  • swelling of the hands, ankles or feet due to water retention.

The above list includes serious side effects that may require medical attention.

Study Selection And Characteristics Of Included Studies

Table 1. Summarized Characteristics of Included Trials.

Figure 1. Flow diagram for the selection of eligible randomized controlled trials.

Figure 2. Network map for patients with normal renal function, mild renal impairment, and moderate renal impairment. Nodes show interventions being compared. Edges represent direct comparison between pairs of interventions. The color of edges represents the level of bias in the majority of included studies in each comparison . War indicates Warfarin. Dab 110 mg indicates Dabigatran 110 mg. Dab 150 mg indicates Dabigatran 150 mg. Riv 10â15 mg indicates Rivaroxaban 10â15mg. Riv 15â20mg indicates Rivaroxaban 15â20mg. Api 2.5mg indicates Apixaban 2.5 mg. Api 5 mg indicates Apixaban 5 mg. Edo 15 mg indicates Edoxaban 15 mg. Edo 30 mg indicates Edoxaban 30 mg. Edo 60 mg indicates Edoxaban 60 mg.

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What To Do If A Dose Is Missed

If you miss a dose of rivaroxaban, apixaban, or edoxaban take one dose as soon as you remember. If you miss a dose of dabigatran, as long as there are 6 hours or more until your next scheduled dose is due, you can take one tablet, otherwise, DO NOT take the dose you have missed. Just take the next dose when scheduled.

Never miss a dose or run out of the medication. Make sure you have a repeat prescription to help reduce your risk of stroke.

Data Sources And Search


The study was conducted in line with the standards of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the Cochrane Handbook. The protocol is documented online . Databases of Medline, Embase, Cochrane Library were searched to identify all potential studies from inception to May 22, 2018. For the theme âNOACs,â we included the following terms: âdabigatranâ or âPradaxaâ or ârivaroxabanâ or âXareltoâ or âapixabanâ or âEliquisâ or âedoxabanâ or âSavaysaâ or âbetrixabanâ or âBevyxxaâ or âNon-vitamin K antagonist oral anticoagulantsâ or âNOACsâ or âdirect oral anticoagulantsâ or âDOACsâ or ânovel oral anticoagulantsâ or ânew oral anticoagulantsâ or âfactor Xa inhibitorsâ or âfactor II a inhibitors.â For the theme âatrial fibrillation,â the terms used were âatrial fibrillationâ or âAF.â For the theme âRCTs,â we included the following terms: ârandomized controlled trialâ or âcontrolled clinical trialâ or âclinical trial.â We used the Boolean operator âANDâ to combine the three comprehensive search themes. In addition, unpublished trials were identified from the Website. Two reviewers independently examined the electronic searches and identified all potentially eligible studies. Disagreements were resolved by consulting a third author .

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What It Looks Like

Eliquis 2.5 mg tablets are yellow and round with “893” on one side and “2 1/2” on the other.

They are packed in blister packs in cartons of 10, 14, 20, 30, 60 or 100 tablets.

Eliquis 5 mg tablets are pink and oval-shaped with “894” on one side and “5” on the other.

They are packed in blister packs in cartons of 14, 20, 28, 56, 60, 100, 112, 120 and 168 tablets.

Not all pack sizes may be available.

In 3 Older Eliquis Users At Risk For Potentially Serious Interactions

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One in three older adults prescribed Eliquis has used an over-the-counter medication or dietary supplement that may cause a potentially serious interaction, according to researchers.

Direct-acting oral anticoagulants, such as Eliquis are the most commonly prescribed anticoagulants, according to Derjung M. Tarn, MD, PhD, a family medicine provider within the department of family medicine, David Geffen School of Medicine at the University of California, Los Angeles, and colleagues.

As direct-acting oral anticoagulants replace warfarin for anticoagulation, it is likely that a significant fraction of direct-acting oral anticoagulants patients also consume OTC products, but specific knowledge about patterns of OTC use is lacking, they wrote in the Journal of the American Geriatrics Society.

Tarn and colleagues surveyed 791 patients prescribed apixaban . Almost all patients reported OTC product use, and 33% took at least one OTC product with potentially serious apixaban interactions either daily or most days. Another 6.7% individuals took multiple OTC products daily or most days that carried the same risk.

Disclosures:Tarn reports funding by the BMS/Pfizer Alliance ARISTAUSA to conduct this study. Please see the study for all other authors relevant financial disclosures.

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The Growing Incidences Of Cardiovascular Disorders Chronic Diseases And Venous Thromboembolism And Increasing Acceptance Of Novel Oral Anticoagulants Are The Major Driving Factors Which Driving The Growth Of Global Anticoagulants Market

Growing incidences of cardiovascular disorders, chronic diseases, and venous Thromboembolism are expected to drive the growth of anticoagulants market. Patients with recognized cardiovascular disease may suffer further cardiovascular procedures, despite receiving optimal medical treatment. Although platelet inhibition plays a central role in the prevention of new procedures, use of anticoagulant therapies to reduce cardiovascular disorders disease. According to American Heart association cardiovascular disease is the leading global cause of death, accounting for more than 17.6 million deaths per year. A number that is expected to grow to more than 23.6 million by 2030.The precise number of people affected by venous thromboembolism is unknown, although as many as 900,000 people could be affected each year in the United States. Oral anticoagulants are widely used for long-term prevention and treatment of venous and arterial thromboembolism. However, stringent regulations set by various governments hamper the growth of the global anticoagulants market. Increasing in development of oral anticoagulants, formulations containing pharmaceutical ingredient with help of new oral anticoagulants technology can provide great opportunities for growth in oral anticoagulants market.

Before You Start To Take It

Christoph Koenen from Bristol-Myers Squibb: The Value of Real-World Data on Eliquis Research

Tell your doctor if you have allergies to any other medicines, foods, preservatives or dyes.

Tell your doctor if you have ever been hospitalised for a heart condition .

Tell your doctor if you have ever received a stent placed in the coronary arteries of your heart.

Tell your doctor if you are 75 years or older or if you have or have had any of the following medical conditions which may lead to an increased risk of bleeding:

  • a heart condition known as bacterial endocarditis
  • type of stroke called “haemorrhagic stroke”
  • blood disorders that affect your ability to form clots and stop bleeding
  • recent or past ulcer of your stomach or bowel
  • moderate or mild kidney disease
  • liver disease
  • have a lung condition called bronchiectasis
  • have had a history of bleeding in your lungs
  • high blood pressure that is not controlled with medications.

Your doctor may decide to keep you under closer observation.

Tell your doctor if you have a prosthetic heart valve or severe rheumatic heart disease, especially mitral stenosis .

Tell your doctor if you know that you have a disease called antiphospholipid syndrome . Your doctor who will decide if the treatment may need to be changed.

If you are having hip or knee replacement surgery and your operation involves a catheter or injection into your spinal column e.g. for epidural or spinal anaesthesia or pain reduction:

If you have not told your doctor about any of the above, tell him/her before you start taking Eliquis.

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A Renal Function Based Trade

  • 1Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China
  • 2Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
  • 3Pharmacy Department, Memorial Healthcare System, Hollywood, FL, United States
  • 4Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
  • 5Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China

Background: Non-vitamin K antagonist oral anticoagulants depend on some degree of renal excretion, and no head-to-head comparisons based on renal function is available. This study mainly investigated the trade-off property of NOACs in nonvalvular atrial fibrillation with varying degrees of renal function.

Methods: A comprehensive search of Medline, Embase, Cochrane Library, and Clinical Website was performed for eligible randomized controlled trials that reported the efficacy and safety outcomes according to renal function of NOACs. Primary efficacy outcome was any Stroke or systemic embolism . Major bleeding was considered as a primary safety outcome. Risk ratios with their confidence intervals , the surface under the cumulative ranking curve , and trade-off analysis were conducted by renal function.


2. Low-dose edoxaban can be considered as a good choice in NVAF patients at high risk of bleeding.


PROSPERO Identifier, CRD42017054235.

Outcomes In Patients With Moderate Renal Impairment

The comparative efficacy results were shown in Figure 3E. In comparison to warfarin, only dabigatran-150 mg was associated with a significant reduction on S/SE. Furthermore, there was no statistically significant difference among NOACs.

In terms of safety, in comparison to warfarin, treatment with apixaban-2.5 mg , edoxaban-15 mg , and edoxaban-30 mg was associated with a significantly reduced rate of major bleeding. In comparisons between NOACs, the risk of major bleeding was lower for patients taking apixaban-2.5 mg or edoxaban-15 mg as compared to patients taking other NOACs . Edoxaban-30 mg showed a significantly higher risk of major bleeding when compared to edoxaban-15 mg .

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Drug Interactions With Non

BC Drug and Poison Information Centre

Reviewed by C. Laird Birmingham, MD, M.H.Sc., FRCPC

Dabigatran and rivaroxaban were the first non-vitamin K antagonist oral anticoagulants on the market in Canada in 2008, followed by apixaban in 2012.1-3 By 2013 they accounted for 23.5% of all prescriptions for oral anticoagulants in Canada.4 Compared to warfarin, NOACs have rapid onset of action, no routine coagulation monitoring and fewer drug interactions.5-8 Yet, case reports of treatment failure and life-threatening bleeding suggest NOACs have problematic drug interactions.9-21

Drugs interact with NOACs by pharmacodynamic and/or pharmacokinetic mechanisms. Inhibition or induction of transporter proteins and metabolizing enzymes cause bleeding and thromboembolism .22-24 Permeability-glycoprotein and breast cancer resistant protein are transporter proteins in the intestinal cell, liver and kidney that excrete drugs into the intestinal lumen, bile duct and urine.25 Both transport apixaban and rivaroxaban.5,8 The prodrug, dabigatran etexilate – not its active metabolite, dabigatran – is transported by P-gp.7,26 See table 1 in this article for more information.

Information on drug interactions with NOACs is incomplete.27 Evidence guiding the safety of drugs used with NOACs includes subanalyses of randomized controlled trials, adverse drug reaction databases, pharmacokinetic studies and spontaneous case reports, but careful interpretation is required.28,29




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