Novel oral anticoagulants: What you should know

Novel oral anticoagulants are a class of drugs that include many recently approved by the U.S. Food and Drug Administration to treat conditions such as atrial fibrillation, deep vein thrombosis and pulmonary embolism. Anticoagulants work by thinning the blood and preventing clots. Novel oral anticoagulants also may be used to prevent clots after hip or knee replacement surgery.

Until the approval of the novel oral anticoagulants, warfarin was the only oral medication available for long-term prevention of blood clots.

Today, there are four FDA-approved novel oral anticoagulants: apixaban (Eliquis, Bristol Myers-Squibb/Pfizer), dabigatran (Pradaxa, Boehringer Ingelheim), edoxaban (Savaysa, Daiichi Sankyo) and rivaroxaban (Xarelto, Janssen Pharmaceuticals). These medications work differently from warfarin, and they do not require frequent re-testing or monitoring. Additionally, they do not require any changes to your diet, whereas patients on warfarin may need to control their consumption of foods containing vitamin K (leafy green vegetables, certain vegetable oils). Novel oral anticoagulants also may not interact with other drugs as much as warfarin.

However, unlike warfarin, the novel oral anticoagulants do not have antidotes approved to reverse their effects in case of serious bleeding, although several are in development. In addition, dosage adjustment based on renal function may be necessary for some of the novel oral anticoagulants.

There are limited clinical data on the long-term effectiveness and safety of novel oral anticoagulants. Each of the drugs works in a very specific way, and your doctor will determine whether one of them is suitable for your treatment plan. Based on specific conditions and your risk for stroke or clotting, you may need to take warfarin, one of the novel oral anticoagulants, or aspirin.

Because anticoagulants thin the blood, it may take longer to stop bleeding while taking these medicines, and more frequent bruising may occur. Contact a health care professional if these effects are of concern. Also contact a health care professional if you observe the following while taking novel oral anticoagulants:

black, bloody or tarry stools;
discoloration of the urine (pink or brown);
coughing or vomiting blood;
persistent nosebleeds;
bleeding of the gums;
weakness or tiredness;
dizziness or fainting;
blurry vision;
arm or leg pain;
difficulty breathing;
trouble swallowing; or
hives.

Additional information can be found at these websites: