Are you on warfarin?
8/22/2024 by Thomas Jaeger, M.D.
Warfarin (Coumadin, Jantoven) has been used for blood thinning for decades. While it has been effective for millions of patients, it also requires careful monitoring. Many factors including diet, medicines and health status can impact its anticoagulant effect. Specialized clinics, usually staffed by pharmacists and nurses, have achieved outstanding safety records for patients taking warfarin. Protocols that utilize knowledge and experience to achieve optimal care lower the risk of bleeding or clotting events.
While most patients taking warfarin do so without complication, there may be considerable effort required to complete necessary monitoring. While half of the patients on warfarin often go months without the need for a dose adjustment, the remainder can require blood testing and dose adjustment much more often. This can be very burdensome. For that reason, many have switched to one of the newer blood thinners known as Direct-Acting Oral Anticoagulants (DOACs) which are consistent in their blood thinning effects and don't require the active monitoring required of warfarin.
Might you be able to switch from warfarin to a DOAC?
The answer depends on several factors. First, there are some indications for anticoagulation for which DOACs are not effective and cannot be used, such as mechanical heart valves. If you aren't sure, you should speak with your healthcare clinician. Second, if you are taking warfarin and have experienced good stability of the dose and don't find the monitoring to be bothersome, the benefits of switching will be limited. While overall DOACs have slightly better safety than warfarin, the difference is not large.
If you don't fall into one of those two categories and are interested in switching, the next factor to consider is out-of-pocket cost for the newer medications. If you have commercial (that is, not government-sponsored) insurance, you should be able to use a manufacturer's coupon to lessen your costs. If your health insurance is government-sponsored, you will need to learn the specifics of coverage for your plan. For those with Medicare part D plans, reimbursement is often quite limited, and out-of-pocket costs can be prohibitive. While one of the DOACs has a generic equivalent available, this drug (dabigatran) is still expensive for most.
Thomas Jaeger, M.D., is emeritus staff, having practiced in the Division of Community Internal Medicine, Geriatrics and Palliative Care for 34 years until his retirement in 2023. He served as medical director of Primary Care Anticoagulation for over 10 years.