For many decades, warfarin (also known as Coumadin) has been the only oral blood thinning (anticoagulation) option for the treatment or prevention of abnormal blood clots (thrombosis).
Heparin, heparin derivatives, and fondaparinux are also used in blood clot management, but must be administered by injection. Both warfarin and these injectables have the benefit of years of clinical research and experience, and guidelines have been developed for their safe use.
New Oral Blood Thinners
The direct oral anticoagulants (DOACs), including apixaban (Eliquis), rivaroxaban (Xarelto), edoxaban (Sayvasa) and dabigatran (Pradaxa), have all been FDA approved in the past 5 years and are being used fairly routinely as alternatives to warfarin.
Clinical trials have shown us they are equally effective and, in fact, can have lower rates of serious bleeding, such as bleeding inside the brain, than warfarin. That said, we have little data on long-term use and are still studying how we can reverse them quickly in the case of major bleeding.
Know Your Options
If you are on blood thinners or will require them, it is important to review options with your hematologist, cardiologist, or your primary care provider to determine which medication is best for you.
Your provider will consider your age, weight, state of health, medications, diet, distance to clinic/lab, ability to self-administer medication, and fall risk among other characteristics.
Below is a table comparing the most common DOACs (apixaban and rivaroxaban) to warfarin.
Emily Parenteau, FNP, is a family nurse practitioner with the Thrombosis and Hemostasis Program at the University of Vermont Medical Center. You can reach the THP at 802-847-4925.