Direct Oral Anticoagulants
Why do I need a blood thinner?
Blood thinners, also called anticoagulants, are medicines that make your blood take longer to
clot. They may be used to:
ξ Prevent strokes in patients that have a heart rhythm called atrial fibrillation
ξ Treat blood clots in your arms, legs, or lungs, sometimes called deep vein thrombosis
(DVT) or pulmonary embolism (PE)
ξ Prevent blood clots in patients that are at risk, such as people who have had a blood clot
in the past or people having major surgery (e.g. orthopedic surgery)
What are direct oral anticoagulants (DOACs)?
Direct oral anticoagulants are a newer type of blood thinner that work in a different way than
warfarin (Coumadin®). The direct oral anticoagulants have some pros and some cons when
compared to warfarin.
Warfarin (Coumadin®) Direct Oral Anticoagulants
(Pradaxa®, Xarelto®, Eliquis®, Savaysa®)
Pros > 50 years’ experience
Effective at reducing blood clot risk
No need for INR testing
Fewer drug interactions
Few diet interactions
Less risk of bleeding in the brain
As effective or more effective than warfarin
Cons Variable dosing
Need for consistent diet
Many drug interactions
Need for regular INR testing
Not reversible (except Pradaxa®)
Not able to easily monitor for high or low levels
Who should not take a direct oral anticoagulant?
Patients with mechanical heart valves should not take direct oral anticoagulants because there is
concern that these patients may have a higher risk of bleeding or stroke.
Patients who have problems with their heart valves or those with poor kidney function should
check with their doctor or pharmacist to find out if a direct oral anticoagulant is right for them.
Which direct oral anticoagulant is right for me?
There are several different factors in choosing which is best for you including:
ξ Cost/Insurance coverage
ξ Whether the medicine can be used for the reason you need a blood thinner
ξ Whether or not you can remember to take a medicine two times every day versus one
time every day
ξ Whether you can take a medicine with food
ξ How well your kidneys work
ξ Whether or not you use a medicine box/organizer
ξ Potential interactions with other medicines you take
Some of the notable differences in the direct oral anticoagulants are listed in the chart below.
Taken twice daily
Option that relies the most on your kidneys to remove drug
Some patients have stomach upset; taking with food may help
Must be stored in manufacturer’s bottle
Cannot be crushed or opened
Reversible with IV idarucizumab
Taken once daily
Should be taken with largest meal of the day
Taken twice daily
Option that relies the least on your kidneys to remove drug
Lower risk of GI bleeding compared to warfarin
Might be used in afib patients on dialysis
Taken once daily
Cannot be used in afib patients with excellent kidney function
Less experience using this DOAC (newest to market)
Will I need to have routine blood tests?
You do not need INR testing with the direct oral anticoagulants. However, your blood counts,
kidney and liver function tests should be checked at least once a year and sometimes more often.
If your kidney function gets worse, the dose may need to be adjusted or it may need to be
Can I afford one of the direct oral anticoagulants?
The direct oral anticoagulants are more expensive than warfarin. If your prescription insurance
does not cover these medicines, cost may be an issue. You can talk with your insurance company
to find out which direct oral anticoagulants are covered. Copay assistance cards are available for
some people. Ask your doctor or pharmacist if you qualify for a copay card.
How do I switch from one blood thinner to another?
If you already take a blood thinner, your doctor or pharmacist will tell you how to switch to your
new blood thinner. It is very important to follow these instructions carefully to avoid gaps in
therapy or overlap of two blood thinners for longer than needed.
Your specific plan:
What if I need to have surgery or a procedure?
Tell all members of your health care team (surgeons, dentist, etc.) that you are taking a blood
thinner. You may need to stop taking it before certain procedures. Be sure to tell your doctor or
pharmacist if you were told to stop or “hold” your blood thinner.
Who to call if you are having a procedure or surgery: _________________________________
Phone number: ______________________________
Are there interactions with other medicines?
There are fewer drug interactions with direct oral anticoagulants than with warfarin. Tell your
doctor or pharmacist all medicines you are taking, including over the counter medicines,
vitamins and herbal supplements. You should also ask before changing any medicines or starting
something new if it can affect your blood thinner. The dose of your blood thinner may need to be
adjusted if you take an interacting medicine.
What are the side effects of direct oral anticoagulants?
All blood thinners will increase the risk of bleeding. Minor bruising, occasional nosebleeds or
heavier than usual menstrual bleeding are common.
Seek urgent medical attention for:
ξ Any bleeding you can’t get to stop after 10 minutes
ξ Red, black, or tarry stools
ξ Vomiting or coughing up blood or “coffee grounds”
ξ Severe headache or stomach ache
*If you have a serious fall or hit your head, go to the emergency room right away
Ask your doctor or pharmacist for more information on possible side effects about the blood
thinner that you will be taking.
What if I am pregnant or become pregnant?
If you think you are pregnant or may become pregnant, tell your doctor right away. It is
unknown how the direct oral anticoagulants might affect a fetus. Your doctor will tell you about
other treatment options.
For more information about your blood thinner:
ξ UW Health Anticoagulation Services website: www.uwhealth.org/anticoagulation
ξ FDA patient medication guides
Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright © 6/2017 University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7826
Direct Oral Anticoagulants
(Xarelto®, Eliquis®, Pradaxa® or Savaysa®)
Take Home Points
ξ Do not stop taking unless you are told to by your doctor.
ξ Never double up on a dose if you forget a dose.
ξ Tell all of your health care team that you are taking a blood thinner.
ξ Know the signs and symptoms of bleeding and report them to your
doctor right away.
o Red, black or tarry stool
o Red or dark brown urine
o Coughing up or vomiting blood
Seek emergency care right away if you:
ξ Fall and hit your head
ξ Experience the signs and symptoms of a…
o Blood clot
Chest pain, shortness of breath
Pain and swelling in an arm or leg
Sudden weakness/numbness on one side of the body
Sudden confusion, trouble speaking or understanding
Sudden vision changes