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How Do New Blood Thinners Compare to Warfarin?

By Sonya Collins
WebMD Feature

Not too long ago, if your doctor said you needed a blood thinner to prevent a stroke, you didn't have to think too hard about it. Warfarin (Coumadin) was the only way to go. But not anymore. With four other medications to pick from, you'll have to do a little homework to figure out what's best for you.

"It's not a one-size-fits-all choice," says Bruce Lindsay, MD, from Cleveland Clinic. A lot depends on your overall health and your lifestyle.

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What Are My Options?

Besides warfarin, you and your doctor will take a look at these new drugs:

Which One Works Best?

Studies show the latest drugs work as well as warfarin. But trying to figure out how the new medicines compare to each other is a bit trickier. There isn’t any research that compares them head to head.

"We can't rank the new ones from one to four," says Richard Kovacs, MD, clinical director of Krannert Institute of Cardiology at Indiana University. "We don't have enough data to suggest one of them over another."

Are the New Drugs Safer?

No matter which one you use, there will be a risk of bleeding problems. Blood thinners work by making it hard for clots to form. That's a good thing when you're trying to prevent a stroke, but it's not so great if it makes it tough to stop a cut from healing.

It's less of a risk with the new medications. And since they wear off faster than warfarin, bleeding problems may not be as serious when they happen.

There's one way that warfarin has the advantage, though. If you get a dangerous bleeding problem, doctors can turn to an "antidote" -- a proven treatment -- to stop it. There's isn't anything like that for the new blood thinners.

How Do the New Drugs Fit Into My Lifestyle?

They have convenience on their side. You don't need as many blood tests. With warfarin, you need them at least once a month to make sure it's working right.

"The blood work can be a burden," Lindsay says. "It's time-consuming and nobody likes to get poked with a needle."

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