For people who need an anticoagulant, warfarin (Coumadin) has been the only oral drug available until recently. It’s not especially expensive, and it’s generally effective. But there are problems with warfarin. Dosing with warfarin is complicated. Blood clots can form if the dose is too low, and bleeding can occur if the dose is too high. The FDA approved alternative anticoagulants for stroke prevention in atrial fibrillation: dabigatran (Pradaxa) in 2010, rivaroxaban (Xarelto) in 2011, and apixaban (Eliquis) late in 2012. These drugs are all either as effective or more effective in preventing stroke and have a reduced rate of bleeding into the brain. For new patients, all of the major guidelines recommend the new drugs as the best option to begin anticoagulation. People already taking warfarin can switch to the new drugs depending on how well they are staying in the targeted therapeutic range of warfarin.
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