Are new anti-coagulants safe to take orally?

Anticoagulant drugs work to reduce the body’s ability to form blood clots. They are given to people who are at high risk of blood clots, thus reducing the chances of them developing serious conditions, like strokes and heart attacks.


Warfarin has been used successfully for many years, to prevent people with atrial fibrillation from having strokes and heart attacks. Warfarin sodium tablets are a prescription drug and have strict guidelines, which must be adhered to. Regular measurements of INR (International Normalised Ratio) are an essential component in the management of people receiving Warfarin treatment.

New Drugs

Recent research has resulted in a number of new oral anticoagulants, such as Dabigatran, Rivaroxaban and Apixaban. These new medicines can be used instead of Warfarin, but do not require close monitoring of blood levels. They therefore offer improved efficacy, relative safety and convenience, compared to Warfarin.


But are there any problems with these new medicines? Warfarin treats and prevents blood clots by decreasing the production of several clotting proteins that rely on vitamin K. If a dose is missed, a patient’s blood may still be adequately thinned, because it takes several days for the anticoagulant effect to wear off. The new medicines work by targeting individual clotting proteins, so if a dose of these new drugs are missed, patients quickly lose the anticoagulant effect and are unprotected from blood clots. In contrast, if patients are waiting to go for an operation, people taking Warfarin must stop several days prior to surgery and inject themselves with shorter acting anticoagulants (often called bridging), but on the new drugs, because they are shorter-acting, bridging is rarely required.

With multiple anticoagulant choices now available, trials to compare them against one another are likely. Trials like this are often carried out by a contract research organization, like Comparison trials could ultimately allow physicians to offer anticoagulation therapy that is highly personalised for each individual patient. Trials like this have not yet been conducted on these new drugs, so until this happens, it is impossible to say that one drug is better than the other.

Healthcare providers are there to help patients understand the advantages and disadvantages of the different anticoagulant therapies. Older generations will probably stick to Warfarin, as it has long proved its worth, whereas younger patients may opt for more convenience.

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