Annals of Phlebology

Table. 1.

Advantages and disadvantages of oral anticoagulants (warfarin versus DOACs)

Warfarin DOACs
Dosing Once-daily dosing may be more convenient. May require more frequent dosing.
Dietary restrictions Need to ensure relatively constant level of vitamin K intake. None. Rivaroxaban should be taken with food when used for atrial fibrillation thromboprophylaxis.
Monitoring therapy PT/INR monitoring is required, which entails regular visits to a facility for most patients (point-of-care devices may be an option for some). Not required; however, noncompliance will not be as readily apparent. It may be reasonable to obtain drug levels in some settings (eg, altered gastrointestinal anatomy) to ensure that the drug is being absorbed.
Reversal agents Several available (eg, vitamin K, FFP, PCC). For dabigatran: idarucizumab; for direct factor Xa inhibitors: andexanet alfa. Activated charcoal may be used to remove unabsorbed drug if the last ingestion was recent. Hemodialysis may be used to remove dabigatran from the circulation.
Monitoring drug activity after reversal PT/INR can be used. TT can be used for dabigatran; anti-factor Xa activity can be used for apixaban.
Effect of comorbid conditions May increase fracture risk, especially in individuals with underlying osteoporosis. Renal function affects pharmacokinetics; dosing unclear in those with obesity.

DOACs: Direct oral anticoagulants include direct thrombin inhibitors (eg, dabigatran) and direct factor Xa inhibitors (eg, apixaban, edoxaban, rivaroxaban).

VTE: venous thromboembolism, PT: prothrombin time, INR: international normalized ratio, FFP: fresh frozen plasma, PCC: prothrombin complex concentrates, TT: thrombin time.

Ann Phlebology 2022;20:9~14 https://doi.org/10.37923/phle.2022.20.1.9
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