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Anticoagulants Other Than Warfarin for Deep Vein Thrombosis

Examples

Generic Name Brand Name
apixaban Eliquis
Generic Name Brand Name
dabigatran Pradaxa
Generic Name Brand Name
rivaroxaban Xarelto

How It Works

Anticoagulants prevent blood clots and keep blood clots from getting bigger. They are also called blood thinners.

Apixaban and rivaroxaban block a blood clotting factor (Factor Xa) from working. Clotting factors are substances that make blood clot.

Dabigatran keeps thrombin from making a blood clot. Thrombin is a substance (enzyme) in the bloodstream that is needed for blood to clot.

Why It Is Used

Dabigatran and rivaroxaban are used to treat deep vein thrombosis and pulmonary embolism.

Apixaban and rivaroxaban are used after knee and hip replacement surgery to prevent deep vein thrombosis and pulmonary embolism.

How Well It Works

Dabigatran and rivaroxaban effectively treat deep vein thrombosis and help prevent it from happening again.1, 2

After knee and hip replacement surgery, apixaban and rivaroxaban help prevent deep vein thrombosis and pulmonary embolism.3, 4, 5, 6

Side Effects

All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

Here are some important things to think about:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • Side effects may go away after you take the medicine for a while.
  • If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Allergic reaction

Call 911 or other emergency services right away if you have:

  • Trouble breathing.
  • Swelling of your face, lips, tongue, or throat.

Call your doctor if you have:

  • Hives.

Bleeding

Call 911 or other emergency services right away if you have:

  • A sudden, severe headache that is different from past headaches. (It may be a sign of bleeding in the brain.)

Call your doctor now or seek immediate medical care if you have:

  • Any abnormal bleeding, such as:
    • Nosebleeds.
    • Vaginal bleeding that is different (heavier, more frequent, at a different time of the month) than what you are used to.
    • Bloody or black stools, or rectal bleeding.
    • Bloody or pink urine.

If you are injured, apply pressure to stop the bleeding. Realize that it will take longer than you are used to for the bleeding to stop. If you can't get the bleeding to stop, call your doctor.

Less serious side effects

Apixaban might cause a skin rash.

Dabigatran might cause stomach upset or stomach pain.

Rivaroxaban does not commonly cause other side effects, such as stomach problems.

Apixaban, dabigatran, and rivaroxaban are newer medicines. So doctors do not yet know if they have any other long-term side effects.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Dabigatran storage. Keep your medicine in its original container or blister pack. Do not use a pill organizer or pill box. This medicine is sensitive to moisture.7

When you take a blood thinner, you need to take extra steps to avoid bleeding problems.

For more information, see:

Click here to view an Actionset.Blood Thinners Other Than Warfarin: Taking Them Safely.

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

Advice for women

If you are pregnant, breast-feeding, or trying to get pregnant, talk with your doctor. Do not use any medicines unless your doctor says it's okay.

If you are pregnant, tell your doctor right away. Apixaban is not recommended for pregnant women. Dabigatran and rivaroxaban have a risk of pregnancy-related bleeding. You and your doctor will decide what medicines are safe for you during pregnancy.

If you are not planning on getting pregnant, talk to your doctor about how you can prevent pregnancy.

Checkups

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Complete the new medication information form (PDF)new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

References

Citations

  1. EINSTEIN-PE Investigators (2010). Oral rivaroxaban for symptomatic venous thromboembolism. New England Journal of Medicine, 363(26): 2499–2510.
  2. Schulman S., et al. (2009). Dabigatran versus warfarin in the treatment of acute venous thromboembolism. New England Journal of Medicine, 361(24): 2342–2352. DOI: 10.1056/NEJMoa0906598. Accessed April 21, 2014.
  3. Lassen MR, et al. (2008). Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty. New England Journal of Medicine, 358(26): 2776–2786.
  4. Eriksson BI, et al. (2008). Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty. New England Journal of Medicine, 358(26): 2765–2775.
  5. Rud Lassen, M., et al. (2010). Apixaban versus enoxaparin for thromboprophylaxis after knee replacement (ADVANCE-2): a randomised double-blind trial. Lancet, 375(9717): 807–815. DOI: 10.1016/S0140-6736(09)62125-5. Accessed April 21, 2014.
  6. Rud Lassen M, et al. (2010). Apixaban versus enoxaparin for thromboprophylaxis after hip replacement. New England Journal of Medicine, 363(26): 2487–2498. DOI: 10.1056/NEJMoa1006885. Accessed April 21, 2014.
  7. Spinler SA, Willey VJ (2011). A patient's guide to taking dabigatran etexilate. Circulation, 124(8): e209–e211.

Credits

By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Jeffrey S. Ginsberg, MD - Hematology
Current as of May 1, 2014

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