Which DOAC Is Best for You

• DOACs are newer blood thinners, an alternative to older drugs like warfarin.
• Used to prevent strokes and treat/prevent blood clots (DVT, PE).
• DOACs generally offer benefits over warfarin including no routine blood monitoring, predictable dosing, fewer drug/food interactions, rapid action, and potentially lower bleeding risk, but they can be more expensive and aren't suitable for all patients.
• Main types: Apixaban (Eliquis), Rivaroxaban (Xarelto), Dabigatran (Pradaxa), Edoxaban (Savaysa).
• Not for everyone: Not used with mechanical heart valves and often need dose adjustments or avoidance with kidney/liver problems.
• Consistency is key: Must be taken as prescribed; missing doses can increase clot risk.

Over 6 million adults in the U.S. have atrial fibrillation, and up to 900,000 Americans each year develop a blood clot in their legs or lungs. These conditions increase your risk of stroke and other serious problems, which is why doctors often prescribe blood thinners.

One group of blood thinners, called direct oral anticoagulants (DOACs), has become a more popular option than older medications like warfarin.

What are DOACs?

DOACs are a newer type of blood thinners that prevent blood clots and treat conditions like deep vein thrombosis (DVT) and pulmonary embolism (PE), as well as to prevent stroke in people with atrial fibrillation.

For many years, warfarin was the standard blood thinner. Warfarin works by reducing the body's production of clotting proteins that depend on vitamin K. However, managing warfarin can be challenging because it requires frequent blood tests to monitor its effectiveness and can interact with many foods and other medications.

DOACs offer a simpler approach. Instead of affecting the body's overall production of clotting proteins, DOACs directly target specific proteins that are active in the bloodstream and block their ability to form clots or make existing clots larger. This more direct action means that regular blood tests are usually not needed to monitor their effectiveness.

Key Advantages of DOACs

• Predictable Action: Their effect on blood clotting is more consistent.
• Less Monitoring: Frequent blood tests are generally not required.
• Faster Action: They start working more quickly than older drugs.
• Quicker Clearance: If stopped, they leave the body faster.

Who Should Not Take DOACs

While DOACs offer several advantages, they are not suitable for everyone. They are generally not recommended for individuals with:

• Severe kidney or liver problems
• A mechanical heart valve
• Significantly low or high body weight

DOACs may also not be the best option for patients with certain stomach surgeries or feeding tubes that can affect medication absorption. Additionally, because DOACs are cleared from the body relatively quickly, it is crucial to take them consistently as prescribed. Missing even a single dose may increase the risk of blood clots.

Effectiveness and Cost

Studies have shown that DOACs are generally as effective as warfarin, and in some instances, they may even be better at reducing the risk of serious bleeding in the brain. However, DOACs can be more expensive and are typically only available as brand-name medications, with the exception of dabigatran (Pradaxa). In rare situations, careful dose adjustments may still be necessary.

Types of DOACs

There are four main DOACs that doctors prescribe today:

• Rivaroxaban (Xarelto)
• Apixaban (Eliquis)
• Dabigatran (Pradaxa)
• Edoxaban (Savaysa)

While all of these medications are used to prevent strokes and treat blood clots, they are not exactly the same. Each one blocks specific clotting proteins, but they differ in how often they’re taken, how they’re handled by your body, and how likely they are to cause certain side effects.

What they have in common

• They are all blood thinners
• No regular blood tests needed
• Taken by mouth:
• Increased bleeding risk
• Not for mechanical heart valves
• Require dose adjustments or may be avoided in patients with kidney or liver problems

Speak with Your Doctor

Choosing the right blood thinner is not always a simple decision. Even though the DOACs on the market have a lot in common, small differences can matter depending on your health history.What works well for one person may not be the best fit for someone else.

Your doctor can help weigh all the pieces, your kidney or liver function, how often you can take a pill, other medications you're on, and even how your body has responded to treatments in the past. These conversations matter. They help make sure you’re not only getting a medication that works but also one you can get the full benefit from.

Every patient’s situation is different. And when it comes to blood thinners, making the right call is always a team decision.