Risks and Benefits of Warfarin Versus New Oral Anticoagulant Drugs

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Excerpt

Q: Several patients have asked me about the risks and benefits of warfarin versus the new oral anticoagulant drugs (NOACs). What information should I give them?
Warfarin had been the outpatient anticoagulation drug available for atrial fibrillation, hypercoagulable states, and deep vein thrombosis (DVT) since mid-1950s. Now we have NOACs. The pros versus the cons of NOACs, compared to warfarin, include:
Pros
1) No laboratory monitoring
2) Few dietary and medication interactions
3) Short duration of action
4) Less comorbidities and improved mortality rate.
Cons
1) NOACs are expensive
2) If a dose is missed, drug levels decrease quickly
3) Antidotes are not widely available
4) Increased adverse events when used in patients with renal disease
5) Some NOACs require twice-daily dosing.
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