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| Warfarin | Dabigatran | Rivaroxaban | Apixaban | Edoxaban | What does it mean for my patient? |
| Mechanism of action | Indirect mode of action (inhibits the production of blood procoagulant factors (i.e. prothrombin and Factors VII, IX and X), as well as of protein C and protein S | Direct Factor IIa (thrombin) inhibitor (prevents thrombin from converting fibrinogen into fibrin) | Direct Factor Xa inhibitors (prevent Factor Xa from converting prothrombin to thrombin) | Not applicable | ||
| Needs to be taken with food | With or without food | With or without food | With or without food for the 10 mg dose; to be taken with food for the 15 and 20 mg doses | With or without food | With or without food | Establishing the most suitable time of day for the patient to take their medication |
| Time to peak activity | Generally 24 h but can be delayed by 72 - 96 h | 0.5 - 2 h | 2 - 4 h | 3 - 4 h | 1 - 2 h | Non-VKA OACs have quicker onset of action compared with warfarin |
| Half-life | 20 - 60 h | 12 - 14 h | 5 - 9 h (young individuals); 11 - 13 h (elderly individuals) | ~12 h | 10 - 14 h | Warfarin has a slower offset of action, meaning it needs to be stopped earlier before surgery |
| GI tolerability* | No problem | Dyspepsia | No problem | No problem | No problem | Dabigatran is not appropriate for patients suffering from dyspepsia |
| Drug interactions (important examples) | Numerous drugs | Contraindicated in patients receiving systemic ketoconazole, ciclosporin, itraconazole and dronedarone; caution needed with amiodarone, posaconazole, quinidine, verapamil, ticagrelor; should be avoided in patients receiving rifampicin, St John’s wort, carbamazepine or phenytoin; contraindicated in patients receiving concomitant anticoagulants | Not recommended in patients receiving azole-antimycotics (such as ketoconazole, itraconazole, voriconazole, posaconazole) or HIV protease inhibitors (e.g. ritonavir); care to be taken with concomitant use of NSAIDs, ASA and PAIs; contraindicated in patients receiving concomitant anticoagulants | Contraindicated (DVT/PE indication)/caution needed (prevention of VTE in patients undergoing elective hip or knee replacement surgery/stroke prevention in AF/VTE secondary prevention indications) in patients receiving rifampicin, phenytoin, carbamazepine, phenobarbital, St John’s wort; not recommended in patients receiving ketoconazole, itraconazole, voriconazole, posaconazole and HIV protease inhibitors (e.g. ritonavir); contraindicated in patients receiving concomitant anticoagulants | Should be used with caution in patients receiving rifampicin; dose reduction in patients receiving ciclosporin, dronedarone, erythromycin, ketoconazole; close scrutiny for bleeding in patients who require chronic treatment with low-dose ASA and/or NSAIDs; contraindicated in patients receiving concomitant anticoagulants | Close surveillance of patients receiving co-medications |
| Renal excretion | Negligible | 85% | ~33% as active metabolite | ~27% | ~50% | Close surveillance of renal function and evaluation of drug choice/dose in patients with renal impairment |