March 22, 2023


Eliquis versus warfarin in the prevention of stroke and systemic embolism and non valvular atrial fibrillation now both of these medications are anticoagulants or blood thinners and what they’re used to do is to prevent blood clots what a blood clot is is when you cut yourself for example a blood clot forms and this is used to create a barrier to prevent further

Bleeding it’s a scab right now that’s how it normally works but what can happen in some situations is that these blood clots or scabs can actually form within the blood vessels and when that happens a barrier forms similar to a scab right barrier forms and it does not allow the passage of nutrients and oxygen and basically what it does is it kills whatever is on

The other saw so what these medications are do are designed to do is to prevent that from happening so what we’re going to do now is we’re going to talk about the mechanisms of the faction because that will be very helpful and then we’ll have a look at what the benefits of each one of these drugs are warfarin is a vitamin k antagonist warfarin works by disrupting

The vitamin k cycle and the vitamin k cycle converts oxidized vitamin k to reduce vitamin k and there is an enzyme in the middle that converts this oxidized vitamin k to reduce vitamin k and that enzyme is where warframes mechanism of action is it stops this conversion and the reason that this is significant is because reduced vitamin k is a critical component of

The synthesis of certain coagulation factors in the liver those coagulation factors being 2 7 9 and 10 so what happens is that warfarin disrupts this vitamin k the vitamin k is necessary for the completion of these coagulation factors so what happens is the liver continues to produce these coagulation factors but without the vitamin k they’re constructed in a way

Where they’re not active so the way that warfarin works is it disrupts these coagulation factors that are important in the coagulation cascade so without these fully functioning coagulation factors the cascade for coagulation the signaling only goes so far and it stops so you don’t fully co ag as normal that’s the way that warfarin works so a good analogy for this

Would be that of car factory right where the cars are the coagulation factors what warfarin does basically is that it disrupts a critical component from being shipped to a car factory so the car factory continues to produce cars but without this critical component all the cars that are made don’t work properly they’re inactive so it would be like if a car factory

Made a car but it never got the shipment for our spark plug right so if you have a car and it doesn’t have a spark plug it can never turn on so therefore it’s an inactive car eliquis works by directly inhibiting coagulation factor 10 to compare that to warfarin warfarin works by inhibiting coagulation factors to 7 9 and 10 and it does this by disrupting the vitamin

K cycle it has since i’ve ever been discovered that to get approximately the same anti coagulation effects as warfarin it’s not necessary to inhibit all the coagulation factors in fact if you just inhibit coagulation factor 10 it gets approximately the same results so the idea here is to make more targeted therapy now going back to our car factory example let’s say

Our car factory produces four cars car two cards seven car nine and car 10 right warfarin works by disrupting the shipment of a critical component to our factory which thereby causes all of our cars leaving our factory to be non-functional right they’re missing the spark plug they don’t turn on and that gets the results we’re looking for but if all we’re trying to

Do is shut down the production of one car we’ve unnecessarily shut down the production of three other cars right so the way eliquis works is that it doesn’t interfere with the production of cars all the cars roll off the assembly line fully functional what it does basically is that it waits outside the factory and it waits for it one particular car car 10 in this

Case to come by and then it puts a boot on it so it stops it from going anywhere it makes it non-functional right so this is basically what the innovation is here what it eliquis does is that it inhibits the coagulation but it does it without interfering with the vitamin k cycle and also without the other coagulation factors now we’ll talk about the benefits of

Each one of these medications and we’ll begin with eliquis the first major advantage to eliquis is that in clinical trials of elk west versus warfarin eliquis was shown to have a lower overall rate of stroke and systemic embolisms and warfarin and this is significant because the whole point of taking these anticoagulant medications is to lower the amount of blood

Clotting which reduces the chance of a stroke or a systemic embolism the second major advantage is also in clinical trials eliquis vs warfarin eliquis was shown to have a lower rate of major bleeds as compared to warfarin and this is significant because the main drawback of anticoagulant medications is that they stop the blood clotting so if you cut yourself it

Will take a longer amount of time for that bleeding to stop thirdly eliquis had a lower all cause mortality rate as compared to warfarin in clinical trials which backs up first two pieces of data having lower all incidents of stroke and embolism and having lower rate of major bleeding fourthly regular inr testing is not required on eliquis this is because the drug

Behaves much more predictably than warfarin and lastly there are significantly fewer medication interactions and diet interactions on eliquis that as compared to warfarin warfarin is notorious for having a lot of medication and diet interactions which is partially the reason why compulsive inr testing is required on warfarin someone may change their diet slightly

And as a result their inr can either lower and put them at risk for stroke or it might rise and put them at risk for major bleeding the main advantage of warfarin is that it is a tremendously well studied and understood drug hundreds of millions of people have taken it generations of people have taken it people’s grandparents have taken it their parents have taken

It and now they’re taking it and as a result almost every health care professional is going to know warfarin very well they all learn about it in school that’s such a common drug that they have to understand how it interacts with the medications their procedures their whatever service they’re offering there whereas with a newer drug it’s a lot of health care

Professionals may have not even learned about it in school or if they don’t prescribe it in someone shows up and they’re on the drug well that makes it more complicated right and also most of the information that we have on the newer drugs come from the drugs clinical trials while the information might be very thorough and very good it’s done in a very narrow range

Of people right it eliquis that would have been done in people with only non valvular atrial fibrillation and that’s the way it’s supposed to be right because if you start including people with other disease states in your clinical trial if they die or have negative effects because of that underlying disease state that is not what they’re trying to treat the blood

Clots then it will mess up your data right more people will be dead or more people will have adverse reactions and it skews the data so you’re supposed to exclude those people but as a result if you have one of those conditions they might not necessarily know that well how it works whereas with warfarin since it’s been around for so many years and so many people

Have taken it everyone understands how it works in their particular disease state in their particular practice warfarin also has an antidote since warfarin works by blocking vitamin k the effects of warfarin can be reversed by simply adding vitamin k where eliquis does not have a reversing agent lastly is the price warfarin is one of the most widely produced drugs

In the world and as a result it’s very inexpensive and widely available even if you wash up on the most remote and poorest country in the world i will guarantee you they probably have warfarin whereas some of the newer drugs the opposite is true where they are likely to be very expensive and not as widely available i hope that gave you a good understanding of the

Differences in the benefits of these two drugs might there be more benefits to eliquis sure absolutely just looking at the mechanism of action we can see that since eliquis is so much more direct acting than warfarin or warfarin inhibits the vitamin k cycle and blocks some other coagulation factors that eliquis does not it might be reasonable to think that eliquis

Would have less side effects but and also i guess as well warfarin is implicated as being implicated a lot of things like osteoporosis and it’s thought to be a result of low levels of vitamin k well since more of the sense eliquis does not block vitamin k it likely would not have those effects but still eliquis is is is still a very new drug and only time will tell

Whether it will be significantly better than warfarin or not so i’ll definitely keep an eye on it if there are any updates i’ll certainly put a link in the side or make a new video about it okay so if you have any other questions you know let me know otherwise i will see you around next time

Transcribed from video
Eliquis vs Warfarin By Sons of Apollo