Alternatives to warfarin

For most people who are already taking warfarin to prevent blood clots, and whose INR is stable, there is little or no benefit in switching to another anticoagulant medicine (e.g. dabigatran or rivaroxaban).

However, if your risk of bleeding is too high, or if you can’t take warfarin for another reason, your doctor may prescribe a different medicine that prevents blood clots. The medicine chosen (another anticoagulant or an antiplatelet medicine) will depend on the medical condition you have.

Do not stop taking warfarin before your doctor tells you to. If you do, you will be at risk of developing blood clots and of having a stroke.

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.

Watch our video, in which specialist Dr John Worthington explains why most people who are already taking warfarin to prevent blood clots, and whose INR is stable, would gain little or no benefit in switching to another anticoagulant medicine (e.g. dabigatran or rivaroxaban).

Other anticoagulant alternatives to warfarin

Your doctor may choose another anticoagulant, such as:

Unlike warfarin, there is no equivalent of the INR blood test to monitor the effect of dabigatran, apixaban or rivaroxaban on blood clotting, or to inform any dose changes.

Some people will prefer not to have ongoing blood tests. For others, the regular INR blood tests that are needed to monitor how well warfarin is working may be reassuring, since it is an easy way to tell if you are at risk of bleeding, and if a dose change is required.

As with all anticoagulants, bleeding is also the main side effect of dabigatran, apixaban and rivaroxaban. However, unlike warfarin there is no specific antidote for dabigatran, apixaban or rivaroxaban  to stop bleeding. So if you do have a serious bleed while you are taking one of these medicines, it may take longer to treat.

Dabigatran, apixaban and rivaroxaban are all subsidised by the Pharmaceutical Benefits Scheme (PBS) for preventing stroke in people with atrial fibrillation, for preventing blood clots after hip and knee replacement surgery, and for preventing blood clots recurring in people who have had a deep vein thrombosis (DVT) or pulmonary embolism (PE) before.

Rivaroxaban is also PBS subsidised for treating DVT (a blood clot in the deep vein of the legs) and PE (a blood clot in the lungs).

Antiplatelet medicine alternatives to warfarin

Alternatively, it may be better for you to take an antiplatelet medicine, such as:

Antiplatelet medicines are not always the right alternative — it depends on your circumstances. Your doctor should take your individual situation and lifestyle into account when prescribing the most suitable anti-clotting medicine for you.

Note: Not all anti-clotting medicines (anticoagulants or antiplatelets) can be used to treat all conditions. Find more information about the anti-clotting medicines that are subsidised by the Pharmaceutical Benefits Scheme, and for which conditions, on the PBS website.