For over 50 years, warfarin was the only anticoagulant drug approved to treat atrial fibrillation, a condition characterized by an irregular heart rhythm. People with atrial fibrillation are at an increased risk for life-threatening blood clots and strokes, and as a blood thinner, warfarin was (and still is) prescribed to keep blood clots from forming.
Now, however, there are a few more medication options available for people with atrial fibrillation. In 2010, the FDA approved four new oral anticoagulants that can be alternatives to warfarin.
What Are the New Anticoagulant Drugs?
The four new anticoagulant drugs are:
• Pradaxa (dabigatran)
• Xarelto (rivaroxaban)
• Eliquis (apixaban)
• Savaysa (edoxaban)
In clinical trials, the FDA found that all four of these drugs were either equivalent to or more effective than warfarin in preventing strokes.
Advantages and Disadvantages
Because anticoagulant drugs prevent blood from clotting, they all come with an increased risk of bleeding that can’t be easily stopped. However, the FDA found that all four of the new anticoagulants have ‘an acceptable risk of bleeding’, meaning that the benefits of the medication outweigh the relatively low risk of uncontrolled bleeding. Two of the drugs, Eliquis and Savaysa, caused less bleeding vs. warfarin in clinical trials. All four of the new drugs were found to be less likely than warfarin to cause a certain type of internal bleeding that can lead to a stroke.
Eliquis Box and Bottle
The new oral anticoagulants also have fewer food and drug interactions than warfarin. There is a long list of prescription and over-the-counter medications that can’t be taken with warfarin due to the risk that they will cause the blood thinner to either be less effective or too effective, and people who take warfarin also need to be careful about eating foods with Vitamin K, since too much Vitamin K can make the medication ineffective.
One other advantage of the new anticoagulant drugs over warfarin is that they require patients to have fewer blood tests. Patients who are taking warfarin need to have frequent prothrombin time tests, which measure how long it takes their blood to clot and allow their doctor to adjust their medication dose if necessary. The new anticoagulants have a fixed dose, and patients usually don’t need the same level of ongoing monitoring.
However, warfarin does still have some advantages over the new anticoagulant drugs. Warfarin has an approved reversal agent (Vitamin K) that can be taken in the event of life-threatening, uncontrolled bleeding. One of the new anticoagulants, Pradaxa, also has a reversal agent, but the FDA has not approved a reversal agent for the other three newer drugs. Additionally, the new medications are unsafe for people with kidney failure or a mechanical heart valve, so patients with these conditions should remain on warfarin.
If you have atrial fibrillation and are considering making the switch to a new medication, you’ll need to discuss your medical history with your doctor to determine a course of treatment that is safe for you. For discounts on these newer oral anticoagulants, search our site.
