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New Frontiers in Heart Medicine: Eliquis, Xarelto and More

New Frontiers in Heart Medicine

Recent years have seen significant progress in managing heart failure (HF), although certain aspects of treatment remain unexplored. One such area is anticoagulation therapy for patients with HF combined with left ventricular (LV) thrombus. The latest developments surround two anti-factor Xa agents—Eliquis (apixaban) and Xarelto (rivaroxaban). These medications are direct oral anticoagulants (DOACs) and have the potential to revolutionize cardiovascular care. 

In this article, we will explore the comparison of the efficacy of Eliquis 2.5 mg tablet compared with Xarelto and discuss the shifting landscape away from warfarin. Other emerging cardiovascular drugs, such as Repatha, Entresto, and Uptravi, will also be discussed, highlighting their potential to improve patient outcomes.

The Rise of DOACs: Eliquis and Xarelto

Warfarin, once a cornerstone in atrial fibrillation (AF) treatment, is gradually being eclipsed by Direct Oral Anticoagulants (DOACs). Eliquis and Xarelto have particularly gained prominence, with nearly 67 per cent of AF patients receiving these newer agents by 2019. Let’s explore why these two drugs have taken center stage.

Eliquis (Apixaban)

Eliquis, a direct oral anticoagulant (DOAC), has gained prominence due to its efficacy and safety profile. It selectively inhibits factor Xa, a crucial component in coagulation. By doing so, it prevents the formation of blood clots without requiring routine monitoring. Numerous clinical trials have demonstrated its effectiveness in preventing stroke and systemic embolism in patients with atrial fibrillation (AF). 

For example, a 2021 study published in Jama Network demonstrated that patients treated with apixaban had a lower risk of major ischemic or hemorrhagic events compared to those treated with rivaroxaban. Eliquis 5mg tablets with predictable pharmacokinetics and minimal drug interactions makes it an effective choice. Also, it boasts a lower risk of major bleeding than warfarin, a traditional vitamin K antagonist (VKA). This advantage has led to its widespread adoption for heart diseases.

Xarelto (Rivaroxaban)

Xarelto, another DOAC, shares similarities with Eliquis but has distinct features. Like Eliquis, it is taken orally. It offers convenience to patients who prefer not to deal with injections or frequent blood tests. It is approved for various indications, including AF-related stroke prevention, deep vein thrombosis (DVT) prophylaxis, and treatment of pulmonary embolism (PE). Its once-daily dosing simplifies adherence and enhances patient compliance.

In a 2022 study published in the journal Frontiers in Pharmacology comparing rivaroxaban to vitamin K antagonists (VKAs) in heart failure patients with left ventricular thrombus, rivaroxaban demonstrated several advantages over VKAs. Notably, it led to a reduction in major cardiovascular adverse events (MACEs) compared to VKAs. Additionally, it significantly lowered the risk of systemic embolism. Although it didn’t substantially improve LV thrombus resolution, its overall efficacy supports its use in heart patients.

Choosing Between Eliquis and Xarelto for Heart Health

As the 2021 study mentioned above already hinted at differences between apixaban (Eliquis) and rivaroxaban (Xarelto). Apixaban demonstrated lower hemorrhagic risk and, in some cases, lower ischemic risk compared to rivaroxaban. However, the debate persisted, leaving healthcare professionals uncertain about the comparative effectiveness of these DOAC agents, which led to further investigation:

A Large Scale Analysis

A groundbreaking study on atrial fibrillation (AF) in elderly populations, conducted by Vanderbilt University Medical Center, was published in JAMA Cardiology in 2022. In the study, researchers examined a large group of 580,000 Medicare beneficiaries aged 65 years or older. These patients had early-onset atrial fibrillation (AF), a common heart rhythm disorder. Here are the key findings:

  1. Genetic Clues: Some of these AF patients carried rare genetic variants linked to cardiomyopathy (a heart muscle condition) and arrhythmia (abnormal heart rhythms).
  2. Higher Risk: Compared to those without the variants, those with these rare variants faced a 1.5-fold higher risk of mortality over 10 years.
  3. Overall Mortality: The overall mortality rate among AF patients with these variants was 24%, while it was 16% for those without the variants.

The results were clear that apixaban emerged as the preferred anticoagulant for AF patients. Here’s why:

  • Reduced Risk: Treatment with rivaroxaban was associated with a significantly increased risk of major ischemic or hemorrhagic events compared to apixaban.
  • Mortality Reduction: Prescribing anticoagulants is crucial in AF to prevent strokes and embolism. Apixaban’s superiority directly benefits patient survival.

Other Heart Medicines Beyond Eliquis and Xarelto

Apart from Eliquis and Xarelto, other cardiovascular drugs are making waves:

1. Repatha

It is a PCSK9 inhibitor designed to lower cholesterol levels. It works by blocking PCSK9, a protein that interferes with the removal of low-density lipoprotein (LDL) cholesterol from the bloodstream. By inhibiting PCSK9, Repatha increases the liver’s ability to clear LDL cholesterol, leading to reduced cholesterol levels. It is expected to play a significant role in managing cardiovascular risk, especially for patients with high cholesterol who are at risk of heart disease or stroke.

2. Entresto

Developed by Novartis, Entresto specifically targets heart failure. It combines two active ingredients: sacubitril (a neprilysin inhibitor) and valsartan (an angiotensin receptor blocker). Neprilysin inhibition enhances the body’s natural protective mechanisms by increasing levels of beneficial peptides. Despite initial setbacks, positive clinical trial results have significantly boosted its sales. Entresto has become an important option for managing heart failure, especially in patients with reduced ejection fraction.

3. Uptravi

It is used to treat pulmonary arterial hypertension (PAH). Its unique mechanism of action involves targeting the prostacyclin pathway. Prostacyclin is a naturally occurring substance that helps dilate blood vessels and prevent abnormal blood clotting. Uptravi mimics the effects of prostacyclin, leading to vasodilation and improved blood flow in the pulmonary arteries. By addressing PAH through this pathway, it sets itself apart from other medications used in this condition.

These drugs represent important advancements in cardiovascular medicine, offering new options for patients and healthcare providers. Always consult with a healthcare professional before starting or changing any medication. Additionally, you can buy Eliquis online at Polar Bear Meds, the best Canadian online pharmacy, to get 100% authentic meds at exclusively discounted prices.


Heart medicine is constantly evolving, with notable advancements beyond traditional therapies such as warfarin. Leading competitors Eliquis and Xarelto offer better efficacy and safety profiles than older treatments. The latest research confirms Eliquis’ superiority in reducing major ischemic and hemorrhagic events in patients with atrial fibrillation. Furthermore, genetic variants in AF patients underscore the importance of personalized treatments. 

Aside from anticoagulants, new medications like Repatha, Entresto, and Uptravi are changing the way we manage conditions such as high cholesterol, heart failure, and pulmonary arterial hypertension. Cardiovascular disease patients can expect improved outcomes and quality of life as a result of these advancements. To optimize patient care and outcomes, healthcare providers need to stay on top of these developments.

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