12/24/21, 9:17 PM Advantages and disadvantages of oral anticoagulants - UpToDate

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Advantages and disadvantages of oral anticoagulants (warfarin versus

direct oral anticoagulants*)

  Warfarin Direct oral anticoagulants*

Dosing Once-daily dosing may be more May require more frequent dosing.
convenient.

Dietary Need to ensure relatively constant None. Rivaroxaban should be taken

restrictions level of vitamin K intake. with food when used for atrial
fibrillation thromboprophylaxis.

Monitoring PT/INR monitoring is required, which Not required; however,

therapy entails regular visits to a facility for
most patients (point-of-care devices
may be an option for some).
noncompliance will not be as readily
apparent. It may be reasonable to
obtain drug levels in some settings
(eg, altered gastrointestinal
anatomy) to ensure that the drug is
being absorbed.

Drug Many. Rivaroxaban interacts with CYP-3A4

interactions and P-glycoprotein inhibitors; other
factor Xa inhibitors interact with P-
glycoprotein; dabigatran may be
affected by P-glycoprotein inducers
or inhibitors.

Time in Approximately 65% based on clinical Expected to be superior to warfarin,

therapeutic trials. although therapeutic ranges have
range not been established.

Reversal Several available (eg, vitamin K, FFP, For dabigatran: idarucizumab; for
agent(s) PCC). direct factor Xa inhibitors: andexanet
alfa. Activated charcoal may be used
to remove unabsorbed drug if the
last ingestion was recent.
Hemodialysis may be used to remove
dabigatran from the circulation.

Monitoring PT/INR can be used. TT can be used for dabigatran; anti-

drug activity factor Xa activity can be used for
after reversal apixaban.

Effect of May increase fracture risk, especially Renal function affects

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12/24/21, 9:17 PM Advantages and disadvantages of oral anticoagulants - UpToDate

comorbid in individuals with underlying pharmacokinetics; dosing unclear in

conditions osteoporosis. those with obesity.

The factors listed may be considered in making decisions regarding choice of oral anticoagulant,
but these must be considered together with clinical information regarding efficacy and toxicity in
specific medical conditions. Refer to the UpToDate topic reviews on specific medical conditions
for clinical data and expert opinion regarding the choice of oral anticoagulants. Refer to
UpToDate topics on warfarin and direct thrombin and factor Xa inhibitors for further details on
administration of these agents and management of bleeding associated with their use. Refer to
UpToDate tables on drug interactions for all agents described herein.

VTE: venous thromboembolism; PT: prothrombin time; INR: international normalized ratio; FFP:
fresh frozen plasma; PCC: prothrombin complex concentrates; rFVIIa: recombinant activated
factor VII; TT: thrombin time.

* Direct oral anticoagulants include direct thrombin inhibitors (eg, dabigatran) and direct factor
Xa inhibitors (eg, apixaban, edoxaban, rivaroxaban).

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