James A. Reiffel, MD - Novel Oral Anticoagulants - Figure 62

NOACs versus Warfarin

This Figure summarizes the characteristics of these new, novel oral anticoagulants in comparison to warfarin:

Equal or superior efficacy;
Equal or less bleeding;
Lower intracranial hemorrhage; and
Stability of dose versus effect.

The NOACs have far fewer drug interactions than warfarin, with the fewest being with dabigatran. Tolerance or discontinuation are equal with the factor Xa inhibitors rivaroxaban and apixaban, or 5% higher than warfarin with dabigatran due to GI bleeding. There is no need for anticoagulant monitoring with the NOACs in contrast to the nuisance of monitoring and maintaining INR levels with warfarin.

On the other hand, generic warfarin is cheap. The new agents depend on insurance plans, but in the cost-effective analyses published to date, looking at not just the cost of the drug but also the cost of hospitalization for higher stroke or higher bleed rates with warfarin, the cost of time off to take the INRs and so forth, these drugs have been found cost effective.

Reiffel JA. Am J Med 2013; 126: 00-00.