Comparison of Warfarin and NOACS

You will find a comparison of warfarin and NOACS below.  Both medication classes are frequently used in practice and a familiarity with these agents is necessary for any practicing pharmacist.  A huge thank you to Aisha Shokoya for putting the majority of this table together.

If you notice something that should be added or changed, please feel free to comment below!

Warfarin NOAC’s
+ ‘s -‘s +’s -‘s
Cost Low Cost & widely available High Cost
Renal Impairment

Dose adjustment

No adjustment necessary for renal impairment Dose adjustments necessary or contraindications for renal impairment
Hepatic Impairment Dose Adjustment Must make dose adjustments, but INR monitoring will guide therapy No dose adjustments but not recommended in severe cases
Monitoring Frequent monitoring of INR with associated cost burdens INR not required
Drug Interactions Many interactions with food & drugs Less interactions; Rivaroxaban interacts with CYP3A4 and P-glycoprotein inhibitors. Dabigatran is affected by P-glycoprotein inducers & inhibitors
Reversal agents Vitamin K Only one agent available for dabigatran only (idarucizumab)
Patients with cardiac valve replacements Only anticoagulant for patients with cardiac valve replacements No use in patients with cardiac valve replacements
Adherence Assessment INR can help assess adherence, once daily dosing nice BID dosing for some, No lab monitoring for adherence
Dietary restrictions Must have consistent level of vitamin K uptake None, except Rivaroxaban should be taken with food for DVT prophylaxis of atrial fibrillation

 

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Written By Eric Christianson

December 4, 2016

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