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Anticoagulants Other Than Warfarin for Atrial Fibrillation


Examples

Generic NameBrand Name
dabigatranPradaxa, Xarelto
rivaroxabanPradaxa, Xarelto

How It Works

Anticoagulants prevent blood clots and keep blood clots from getting bigger. They are also called blood thinners.

Dabigatran keeps thrombin from making a blood clot. Thrombin is a substance (enzyme) in the bloodstream that is needed for blood to clot.

Rivaroxaban blocks a blood clotting factor (Factor Xa) from working. Clotting factors are substances that make blood clot.

Why It Is Used

Anticoagulants are used to lower the risk of stroke and blood clots in people who have atrial fibrillation.1

Your doctor may recommend an anticoagulant based on your risk of having a stroke. If you are age 55 or older and have atrial fibrillation, you can find your risk of stroke using this Interactive Tool: What Is Your Risk for a Stroke if You Have Atrial Fibrillation?Click here to see an interactive tool.

Dabigatran and rivaroxaban are newer medicines than the anticoagulant medicine warfarin. Warfarin has been used for many years to help prevent stroke in people who have atrial fibrillation. If you are thinking about taking a newer anticoagulant instead of warfarin, talk with your doctor to see if it is right for you.

Reasons why you might take dabigatran or rivaroxaban include:

  • You cannot take warfarin safely, such as not being able to keep a safe level of warfarin in your blood (INR).
  • You have side effects from warfarin that are hard to live with.
  • You do not want to have to get regular blood tests and watch how much vitamin K you eat. Both are needed if you take warfarin.

You cannot take dabigatran or rivaroxaban if you have heart valve disease, an artificial heart valve, or severe kidney or liver disease.

Click here to view a Decision Point.Atrial Fibrillation: Which Anticoagulant Should I Take to Prevent Stroke?

How Well It Works

Dabigatran and rivaroxaban lower the risk of stroke in people who have atrial fibrillation.2, 3

How much your risk for a stroke will be lowered depends on how high your risk was to start with. Not everyone who has atrial fibrillation has the same risk of stroke. It's a good idea to talk with your doctor about your risk.

You will want to weigh the benefits of reducing your risk of stroke against the risks of taking an anticoagulant. Anticoagulants can help prevent stroke. But this medicine also raises the risk of bleeding. Your own risk of bleeding may be higher or lower than average, based on your own health.

Side Effects

All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

Here are some important things to think about:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • Side effects may go away after you take the medicine for a while.
  • If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Bleeding

Call or other emergency services right away for signs of serious bleeding:

  • You cough up blood.
  • You vomit blood or what looks like coffee grounds.
  • You pass maroon or very bloody stools.
  • You have a sudden, severe headache that is different from past headaches. (It may be a sign of bleeding in the brain.)

Call your doctor right away if you have unusual bleeding such as:

  • You have new bruises or blood spots under your skin.
  • You have a nosebleed that doesn't stop quickly.
  • Your gums bleed when you brush your teeth.
  • You have blood in your urine.
  • You have heavy period bleeding or vaginal bleeding when you are not having your period.

If you are injured, apply pressure to stop the bleeding. Realize that it will take longer than you are used to for the bleeding to stop. If you can't get the bleeding to stop, call your doctor.

Allergic reaction

Call or other emergency services right away if you have:

  • Trouble breathing.
  • Hives.
  • Swelling of your face, lips, tongue, or throat.

Dabigatran might cause less serious side effects including:

  • Stomach upset.
  • Stomach pain.

Rivaroxaban does not commonly cause other side effects, such as stomach problems.

Dabigatran and rivaroxaban are newer medicines. So doctors do not yet know if they have any other long-term side effects.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Taking anticoagulants safely

Do not stop taking your medicine without talking with your doctor first.

Take extra steps to prevent bleeding problems such as:

  • Prevent falls and injuries.
  • Tell your doctors about all other medicines and vitamins that you take.
  • Know what to do if you miss a dose of anticoagulant.
  • Before any surgery or medical or dental procedure, talk to your doctor about whether you need to stop taking dabigatran for a short time beforehand.

Dabigatran and rivaroxaban work differently from warfarin to prevent blood clots. So some of the precautions and safety tips for these newer anticoagulants are different from those for warfarin. Just as with warfarin, you need to take extra steps to prevent bleeding. But with these newer medicines, you do not need regular blood tests, and you do not need to watch how much vitamin K (found in many vegetables) you eat or drink.

Click here to view an Actionset.Blood Thinners Other Than Warfarin: Taking Them Safely

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

Advice for women

If you are pregnant, breast-feeding, or planning to get pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breast-feeding, or planning to get pregnant.

Checkups

Follow-up care is a key part of your treatment and safety. You might have regular tests to check how well your kidneys are working.

Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Complete the new medication information form (PDF)Click here to view a form.(What is a PDF document?) to help you understand this medication.

References

Citations

  1. Fuster V, et al. (2011). 2011 ACCF/AHA/HRS focused update incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 123(10): e269–e367.

  2. Connolly SJ, et al (2009). Dabigatran versus warfarin in patients with atrial fibrillation. New England Journal of Medicine, 361(12): 1139–1151.

  3. Patel MR, et al. (2011). Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. New England Journal of Medicine, 365(10): 883–891.

Credits

ByHealthwise Staff
Primary Medical ReviewerAdam Husney, MD - Family Medicine
Specialist Medical ReviewerE. Gregory Thompson, MD - Internal Medicine
Last RevisedFebruary 8, 2012

eMedicineHealth Medical Reference from Healthwise

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