Comparison of outpatient anticoagulant drugs
| Vitamin K antagonists | Direct oral anticoagulants | Parenteral anticoagulation | |||||
|---|---|---|---|---|---|---|---|
| Warfarin | Dabigatran | Apixaban | Rivaroxaban | Edoxaban | Low-molecular-weight heparins | Fondaparinux | |
| Target | Vitamin K | Thrombin | Factor Xa | Factor Xa | Factor Xa | Antithrombin III | Factor Xa |
| Dosing | Once daily | Twice daily | Twice daily | Once daily | Once daily | Once or twice daily | Once daily |
| Monitoring needed | Yes (INR) | No | No | No | No | No | No |
| Comorbidity-specific recommendations | Recommended for patients with antiphospholipid syndrome | Recommended for patients with active cancer with no gastrointestinal or genitourinary involvement: rivaroxaban, apixaban, or edoxaban Recommended for patients with cancer with gastrointestinal or genitourinary involvement: apixaban For patients with recent acute coronary syndrome, avoid dabigatran | Recommended for patients with active cancer and for pregnant patients | Recommended for patients with high-risk superficial vein thrombosis | |||
| Liver dysfunction considerations | Can be used in patients with increased prothrombin time or INR | Avoid in patients with increased prothrombin time or INR | Can be used in patients with increased prothrombin time or INR | Recommended for patients with high-risk superficial vein thrombosis; use with caution, monitor closely for signs of bleeding | |||
| Renal dysfunction considerations | Can be used in patients with creatinine clearance rate < 30 mL/min | For patients with creatinine clearance 30–50 mL/min, preferred agents are rivaroxaban, apixaban, or edoxaban Avoid all direct oral anticoagulants in patients with creatinine clearance rate < 30 mL/min | Use doses adjusted for renal function as recommended in product labeling | Avoid in patients with creatinine clearance rate < 30 mL/min | |||
INR = international normalized ratio
Based on information in references 11 and 21–24.