Will Warfarin Remain the Cornerstone Anticoagulant?

The use of warfarin will likely remain common for the foreseeable future. But, considering the newest generation of oral anticoagulants, warfarin’s status as a mainstay anticoagulation therapy is uncertain, says Yekaterina Opsha, PharmD, BCPS-AQ Cardiology, a clinical specialist of cardiovascular medicine at Saint Barnabas Medical Center.

The novel oral anticoagulants do not have direct reversal agents, so some physicians may shy away from using them in certain patient populations, she notes.

Meanwhile, warfarin is “fairly predictable” based on international normalized ratios if the patient is fully anticoagulated or has a risk of bleeding, Dr. Opha says. Plus, warfarin has been around for decades.

“I don’t think this drug is going away,” says Dr. Opsha, who is also a clinical assistant professor at the Rutgers Ernest Mario School of Pharmacy.

If reversal options were available for factor Xa inhibitors, however, then practitioners may feel more comfortable using this alternative, Dr. Opsha says.