Version July 2025
| Warfarin | Direct oral anticoagulants* | |
| Dosing | Once-daily dosing may be more convenient. Anticoagulant intensity may be titrated if needed for patients who require a higher INR. | May require more frequent dosing. |
| Dietary restrictions | Need to ensure relatively constant level of vitamin K intake. | None. Rivaroxaban doses ≥15 mg should be taken with food. |
| 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, nonadherence 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. |
| Drug interactions | Many. | Rivaroxaban and apixaban interact with CYP-3A4 and P-glycoprotein inhibitors or inducers; edoxaban and dabigatran interact with P-glycoprotein inducers or inhibitors. |
| Time in therapeutic range | Approximately 65% based on clinical trials. | Expected to be superior to warfarin, although therapeutic ranges have not been established. |
| Reversal agent(s) | Several available (eg, vitamin K, FFP, PCC). | For dabigatran: idarucizumab; for direct factor Xa inhibitors: andexanet alfa or PCC. 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. | Kidney function affects pharmacokinetics; dosing unclear in those with obesity. |
FFP: fresh frozen plasma; INR: international normalized ratio; PCC: prothrombin complex concentrates; PT: prothrombin time; rFVIIa: recombinant activated factor VII; TT: thrombin time; VTE: venous thromboembolism.
* Direct oral anticoagulants include direct thrombin inhibitors (eg, dabigatran) and direct factor Xa inhibitors (eg, apixaban, edoxaban, rivaroxaban).