Alternatives to Warfarin

Medically reviewed by Alan Carter, PharmD on July 28, 2017Written by University of Illinois-Chicago, Drug Information Group on June 7, 2016

Introduction

For decades, warfarin has been one of the most popular drugs used to prevent and treat deep vein thrombosis (DVT). DVT is a dangerous condition caused by blood clots in your veins.

Warfarin is effective, but there are some downsides. Your doctor needs to monitor your blood frequently while you take it. Warfarin also interacts with many other drugs, and it can be affected by changes in your diet. Newer alternatives to warfarin have benefits as well as drawbacks compared with warfarin.

What are the alternatives to warfarin?

Newer medications are now available as alternatives to warfarin. Some of these drugs are oral medications. Others you inject under your skin. The table below lists warfarin alternatives.

Drug nameBrand nameOral or injectable
ApixabanEliquisOral
DabigatranPradaxaOral
DalteparinFragminInjectable
EdoxabanSavaysaOral
EnoxaparinLovenoxInjectable
FondaparinuxArixtraInjectable
RivaroxabanXareltoOral

How do they work?

Like warfarin, these drugs prevent a blood clot from getting bigger. They also reduce your chance of developing another clot. However, the way they work in your body is different from the way warfarin works. They affect a different part of the clotting process. This difference often makes these newer drugs convenient to use.

Advantages

There are many advantages of these newer drugs compared with warfarin. They start working faster when you begin treatment, and their effects don’t last long after you stop taking them. You also don’t have to have as many tests to see if your blood-thinning level is in the right range. These drugs have fewer negative interactions with other drugs, and they aren’t affected by your diet or dietary changes.

Advantages

  1. These drugs start and stop working more quickly.
  2. You need fewer tests during treatment.
  3. The effectiveness is not changed by your diet.

Disadvantages

There are also disadvantages of these newer drugs compared with warfarin. For example, they’re only available as brand-name drugs, so they’re more expensive. You should check with your insurance company to see if they cover these medications and how much your copay will be. Many insurance companies require a prior approval of these medications. This means that your doctor may have to contact the insurance company and provide information before you can fill the prescription.

Also, these newer drugs have not been around as long as warfarin and there is no antidote available at this time. The long-term effects of these drugs are not known like they are for warfarin.

Disadvantages

  1. Generic versions aren’t available, so these drugs are more expensive.
  2. These alternatives may increase bleeding risk for certain people.
  3. The drugs haven’t been studied as well as warfarin, so long-term effects are not known.

About DVT and prevention

DVT is a blood clot that forms in one or more large deep veins in your body, usually your legs. Veins return blood to your heart. The blood flow in your veins is slower than the blood flow in your arteries because it doesn’t have as much momentum from your heartbeat. If you’re moving less than normal, your blood flow becomes even slower. When your blood flow is slower than normal, the risk of blood cells clumping together in your blood vessels is greater. This is especially true in your larger veins, which carry more blood.

DVT is more likely to happen in people who move less than normal. These might be people who have just had surgery, people who have been in an accident that’s limited their movement, or people who are older and may not move around as much. People that have a condition that affects how the blood clots may also be at risk for DVT.

Whether your doctor prescribes warfarin or one of the new alternatives to prevent or treat your DVT, it’s important that you follow the therapy. If you don’t treat DVT, the clot can get bigger and break loose. If it breaks loose, it can flow in your bloodstream through your heart. Then, it can enter the small blood vessels of your lungs, where it can lodge and block your blood flow. This is called a pulmonary embolism, and it may be fatal.

Things to remember

There are alternatives to warfarin in the prevention and treatment of DVT. When considering these drugs, remember:

  • There are both advantages and disadvantages to these drugs.
  • These drugs are not for everyone. Only your doctor can tell you if these drugs are right for you.
  • You should call your insurance company if you’re prescribed one of these drugs to make sure that your plan covers it.
  • It’s very important to complete your DVT prevention or treatment therapy.
CMS Id: 104916