How to Choose an Anticoagulant

Anticoagulants dabigatran, rivaroxaban and warfarin compared for bleeding risk

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) If you need to take an anticoagulant — popularly known as a blood thinner — you don’t want it to cause bleeding, but some might raise your bleeding risk. 

A new study compared three of these medications. The medications were dabigatran (brand name Pradaxa), rivaroxaban (Xarelto) and the older medication warfarin (Coumadin). The authors of this study found that the risk of gastrointestinal bleeding was highest among people using dabigatran and lowest among those using warfarin.

These study authors said they could not rule out a considerable increase in risk of bleeding between the two newer medications and warfarin.

The research team, led by Dr. Hsien-Yen Chang, an assistant scientist at the Johns Hopkins Bloomberg School of Public Health, wrote that “Evidence from observational studies such as ours should prove useful to clinicians in selecting the appropriate anticoagulant for patients after incorporating other information about the safety, efficacy, and effectiveness of these agents, as well as their cost and patients’ preferences regarding anticoagulant therapy.”

Anticoagulants don’t really thin the blood. But they do make it less likely to clot.

These drugs are used for people who have had a stroke or a condition called atrial fibrillation (irregular heart rate). Patients with these conditions may have a higher risk of blood clots than healthy people.

The downside of anticoagulants is that they can cause bleeding, especially in the stomach and intestines. Doctors manage the risk of bleeding through careful monitoring and frequent lab tests.

Dr. Chang and team looked at data on more than 46,000 US patients with commercial insurance (as compared to Medicare or Medicaid).

The overall risk of gastrointestinal bleeding was essentially the same for all three medications. Dabigatran had the highest bleeding risk, and warfarin had the lowest, but Dr. Chang and team said the differences were not statistically significant.

Dr. Chang and colleagues noted, however, that risks might be higher for older patients. These researchers said that, despite the very small differences in risk, they could not completely rule out the slightly higher risk of bleeding for both of the newer medications when compared to warfarin.

This study was relatively short. Long-term use or higher doses of dabigatran and rivaroxaban might increase the risk of bleeding, Dr. Chang and team noted.

This study was published in the April Issue of The BMJ.

Although this study did not receive outside funding, author Dr. G. Caleb Alexander received funds from the National Heart, Lung and Blood Institute. Dr. Alexander said he was the chair of the FDA’s Peripheral and Central Nervous System Advisory Committee and a paid consultant to IMS Health.

Review Date: 
April 27, 2015
Last Updated:
May 11, 2015