Warfarin or Dabigatran or Xarelto… the choice is a team decision

Publication Date: 
Mon, 05/07/2012
By: Alere Staff

If you take warfarin (or brand of warfarin such as Coumadin®) and watch television, you have likely seen the commercials for Pradaxa®, a new blood thinner (anticoagulant). Pradaxa® medication has been developed to replace warfarin for patients with atrial fibrillation. You may have wondered if this medication is right for you.

This new medication and all other medications used to prevent dangerous blood clots, including warfarin, carry a risk of causing serious bleeding. Your doctor will determine the best medicine to help keep you protected from dangerous blood clot development. However, you have an important voice in that decision because you have to take the medication and, of course pay for it.

The Pradaxa® and Xarelto® anticoagulants are new medications approved by the FDA for stroke prevention in patients with atrial fibrillation. These medications do require monitoring but not as frequently as warfarin. An additional feature of these new medications is their high cost. Warfarin costs approximately 11 cents per day while newer medications can cost well over $6 per day. Choosing a medication you can afford is important and may affect the way you take the medicine over time.

A new study published in the March 2012 American Heart Journal looked at whether the Pradaxa® medication or warfarin was more cost-effective for you. The study found that if you can keep your time in INR (International Normalized Ratio) target range at or above 73% - warfarin is a more cost-effective choice for patients.1

How do you keep your test results in range at or over 73%? The answer may be weekly self-testing. Several studies have shown that by testing weekly (even if you are a stable warfarin patient) you can improve your time in range. 2,3 Weekly testing is practical and easily done by patients who self test in the privacy of their home. Share with your doctor your desire to self test as self testing begins with a prescription.

New medications represent a choice for carefully selected patients. New isn’t always better or safer but in this case, it is far more expensive than warfarin. If you’re wondering what medication is right for you, consider testing your INR at home with your doctor’s support before switching to something because it’s new.

  1. Kamel, K. Cost-effectiveness of dabigatran compared to warfarin for stroke prevention in patients with atrial fibrillation and prior stroke or transient ischemic attack. Stroke, 43:881-883. March 2012
  2. Henegan, C., et al. Self monitoring of oral anticoagulation: a systemic review and meta-analysis. Lancet. 2006. 367, 404-11.
  3. Ansell, J. Patient Self-Testing: Real-World Experience Within a Comprehensive Support Service Represents a New Standard of Care, Attaining High Quality Anticoagulation Control.Poster presented at: American College of Cardiology. March 2012.


COUMADIN® is a registered trademark of Bristol-Myers Squibb Pharma Company. Alere is not affiliated or associated with Bristol-Myers Squibb Pharma Company or the COUMADIN® trademark.