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.
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.
If you get a dangerous bleeding problem while taking warfarin, doctors can turn to an "antidote" of Vitamin K or a combination of prothrombin complex concentrate (PCC) and fresh frozen plasma to stop it. In addition, approval has been given for using idarucizumab (Praxbind) in emergencies to reverse the anit-clotting effects of Pradaxa.
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."
There's one more issue with warfarin. You need to keep an eye on how much vitamin K is in your diet. It's the nutrient in a lot of leafy green veggies, and it affects how well the drug works. You need to be consistent in how much you eat.
"It's not that you can't eat salads," Lindsay says. "If you always eat the same thing, it's fine. But if you vary your diet, in terms of salads, it's going to affect your dose."
None of this is an issue for the new drugs. Vitamin K doesn't interfere with how they work.
Will My Other Meds Cause Problems?
Some prescription and over-the-counter drugs make it harder for warfarin to work. Others make the medicine work too well -- and raise your risk of bleeding.
And we're not just talking about a handful of drugs to avoid. "It's a huge list of medications that can interact with it, which can be a problem when you need to take something for another issue," Lindsay says.
It's not as big a deal with the new blood thinners. There are some drugs that don't mix well, but not nearly as many as with warfarin.
Should I Switch From Warfarin?
These new additions to the blood thinner family have some benefits over the old. But that doesn't mean you should drop your prescription.
Stay on warfarin if you have kidney failure. The same goes if you have mechanical heart valves, Lindsay says. The new meds may not be safe for those situations.
What's more, if the old standby works well for you, your doctor might not suggest a change.
"If you've been on warfarin, you're stable, don't have bleeding problems, and don't mind going to the laboratory," Kovacs says, "in my opinion, there's generally not a compelling reason to switch."