Move Over Warfarin – No, Really

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Of all the new oral anticoagulants set to take over for Coumadin (warfarin) the new drug Xarelto just scored a trifecta. Remember these newer blood thinners are much more convenient than warfarin because you are spared the weekly blood tests to monitor your INR (coagulation levels).

Xarelto (rivaroxaban) has been approved by the FDA for the treatment of deep vein thrombosis (DVT) and/or pulmonary embolism (PE), and to reduce the risk of recurrence of DVT and PE after initial treatment. Xarelto was previously approved to reduce the risk of DVT and PE after knee- or hip-replacement surgery, and to reduce the risk of stroke in persons with atrial fibrillation.

Xarelto received this approval after studies showed it was as effective as enoxaparin (Lovenox) and warfarin for treating DVT and PE. The major adverse effect observed with Xarelto use was bleeding, similar to the other blood thinners.

Unlike other oral anticoagulants available, only Xarelto is a factor Xa inhibitor. Unlike with warfarin, routine blood monitoring is not required for patients receiving Xarelto.

Pradaxa (dabigatran) was the first oral anticoagulant to be approved since warfarin 50 years ago and now there are several new choices including Xarelto. Pradaxa works slightly different than Xarelto and is a direct thrombin inhibitor. They are much more convenient but the cost makes them impossible for some patients.

For those of you on them, is it worth the cost?

Dr O.

Drugs featured in this story

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