Dabigatran: other medicine options
Dabigatran (Pradaxa) may not be suitable for some people (see Who should not take dabigatran). If dabigatran is not suitable for you, your doctor will prescribe another anti-clotting medicine according to your medical condition, your individual situation and lifestyle.
Dabigatran is a fairly new anticoagulant ( a type of anti-clotting medicine), so its long-term side effects are still being understood. For this reason, some doctors are more likely to prescribe other anticoagulant medicine they are more familiar with — such as warfarin (Coumadin, Marevan) for preventing stroke in people with atrial fibrillation.
If you are already taking warfarin to prevent blood clots, and your INR is stable, there is little or no benefit in switching to dabigatran or another anticoagulant medicine (e.g. rivaroxaban or apixaban).
If you would like to know more about your treatment options or if you have any questions or concerns about your medicines, always speak to your doctor or pharmacist.
Other anti-clotting medicines
Other anti-clotting medicines include:
- warfarin (Coumadin, Marevan)
- aspirin (e.g. Astrix, Cartia, Solprin)
- apixaban (Eliquis)
- rivaroxaban (Xarelto)
- enoxaparin (Clexane)
- dalteparin (Fragmin)
- fondaparinux (Arixtra)
For most people who are already taking warfarin, and whose INR is stable, there is little or no benefit in switching to dabigatran.
To make sure that you are taking the correct dose of warfarin and that it is working safely and effectively in your body, you must have regular blood tests. The International Normalised Ratio, or INR blood test checks how long it takes for your blood to clot. The higher your INR, the longer it will take blood to clot (and the higher the risk of bleeding). The lower the INR, the more likely you are to develop a blood clot. Find out more about the INR test.
Your INR can be affected by many other medicines and some foods. If you take warfarin, you will need to eat a consistent diet. Find out more about warfarin, diet and warfarin and warfarin’s side effects and interactions.
If you’re thinking about switching to warfarin from dabigatran, read our information comparing dabigatran and warfarin.
Apixaban and rivaroxaban
Like warfarin and dabigatran, apixaban (Eliquis) and rivaroxaban (Xarelto) are anti-clotting medicines called anticoagulants. These medicines can be used to prevent a stroke in people with atrial fibrillation, and they are also used to prevent harmful clots from forming.
Apixaban and rivaroxaban are subsidised by the Pharmaceutical Benefits Scheme (PBS) for preventing blood clots in people who have had hip or knee replacement surgery, for preventing blood clots recurring in people who have had one before, and to prevent stroke in people with atrial fibrillation.
Aspirin is commonly only given to people with atrial fibrillation who are younger than 65 years of age, and who have no other risk factors for stroke. It is not as effective for people at high risk of stroke.
Aspirin may also be given (instead of warfarin) to people aged 65 years and over who have other risk factors for stroke if their risk of bleeding would be too high on warfarin.
Find out more about aspirin.
Injectable anti-clotting medicines
Injectable anti-clotting medicines are commonly used to prevent harmful blood clots from forming after hip or knee replacement surgery — particularly enoxaparin (Clexane) and dalteparin (Fragmin), which are low molecular weight heparins. Another injectable medicine called fondaparinux (Arixtra) is also available.
Enoxaparin has been available for a few years, and is the standard treatment for preventing clots after hip or knee replacement surgery. However, as enoxaparin is given as an injection, dabigatran may be more convenient for some people because it is taken by mouth. For more information about injectable anti-clotting medicines, see our low molecular weight heparins and fondaparinux pages.
Phone for medicines information
Call NPS Medicines Line on 1300 MEDICINE (1300 633 424, Monday–Friday, 9am–5pm AEST) to get information about your prescription, over-the-counter and complementary medicines (herbal, 'natural', vitamins and mineral supplements) from a pharmacist. Your call will be answered by healthdirect Australia.
Find out more about:
- Rossi S, ed. eAMH [online]. Australian Medicines Handbook, January 2013. www.amh.net.au (accessed June 2013).
- Cardiovascular Expert Group. Therapeutic guidelines: cardiovascular. Therapeutic Guidelines Ltd; 2013. www.tg.org.au (accessed June 2013).
- NPS Medicine Update, April 2010. Dabigatran (Pradaxa) for preventing blood clots after hip or knee replacement surgery
- NPS Medicine Update, August 2011. Dabigatran (Pradaxa) for preventing stroke in people with atrial fibrillation