For years, the only oral anticoagulant available to prevent strokes among those with afib was warfarin (Coumadin®). It works well but can be challenging to take because it requires regular blood tests to ensure you are taking just the right amount. Too much could lead to excess bleeding; too little might not prevent blood clots and thus lead to a stroke. Plus, warfarin has numerous interactions with food and other medications.1
In 2010, the US Food and Drug Administration (FDA) approved dabigatran (Pradaxa®), the first in a new class of oral anticoagulants. This new class is referred to as Direct (or direct-acting) Oral Anticoagulants, often called DOACs. You may also see them referred to as Non-Vitamin K Antagonist (or New or Novel) Oral Anticoagulants (NOACs) or Target-Specific Oral Anticoagulants (TSOACs). However, the terms NOAC and TSOAC are much less commonly used now than the term DOAC.
Since the approval of dabigatran, three other DOACs have been approved: rivaroxaban (Xarelto®), apixaban (Eliquis®), and edoxaban (Savaysa®).
None of the DOACs require regular blood tests or special diets like warfarin does. Studies found that each worked as well or even better than warfarin at preventing strokes and similar events, usually with a lower risk of bleeding.
An analysis of 48 trials of these drugs involving more than 71,000 people found that the DOACs reduced the risk of stroke or similar events by 19 percent more than warfarin. They also reduced the risk of death from any cause by 10 percent more than warfarin. Significantly, the DOACs reduced the risk of bleeding in the brain, a feared complication from anticoagulants, by 52 percent. However, with the DOACs, there was a 25 percent increase in the risk of stomach bleeding.2
DOACs are recommended over warfarin except for those with valvular afib (mechanical heart valves or moderate-to-severe mitral stenosis).3 DOACs should not be used for those with valvular afib.4 DOACs may be acceptable for those with a bioprosthetic heart valve or valve repair three months or more after the procedure.4 Those with kidney and liver disease should be evaluated before starting a DOAC and each year after that.3
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To learn more about specific direct oral anticoagulants, click on the links below.
To learn more about how you and your doctor can decide if an oral anticoagulant is appropriate for you, see Anticoagulant Medication to Prevent Strokes
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