UC Davis Health
Pharmacy

Direct Oral Anticoagulants (DOAC)

What is a Direct Oral Anticoagulants (DOAC)?

Traditional anticoagulants such as warfarin (Coumadin) and heparin are in widespread use. Newer anticoagulants, novel oral anticoagulants (NOAC) or directly acting oral anticoagulants (DOAC) include a direct thrombin inhibitor (dabigatran) and factor Xa inhibitors (rivaroxaban, apixaban, and edoxaban). These medications work differently than warfarin while still achieving similar anticoagulation effects.

differences between warfarin and DOAC
This diagram shows the different mechanisms of how warfarin and direct oral anticoagulants work to have similar anticoagulation effects.

Who is NOT indicated to take a DOAC?

DOAC medications can be used for a variety of indications such as stroke prevention with atrial fibrillation or venous thromboembolism treatment. However, there are several situations in which DOAC medications are not preferred.

  • Severe kidney or liver dysfunction
  • The cost of the medication is too high
  • Weight less than 110lbs or greater than 308lbs
  • Having a mechanical heart valve
  • Gastrointestinal absorption issues (e.g. history of bariatric surgery or other gastric revisions, certain feeding tubes)
  • History of poor medication adherence

Always talk to your doctor or pharmacist before starting or stopping any medication.

What are the advantages and disadvantages of DOACs compared to warfarin?

This table compares the advantages and disadvantages of direct oral anticoagulants compared to warfarin.

Advantages

Disadvantages

  • No INRs
  • Rapid onset (medication takes effect within a few hours)
  • No diet restrictions
  • Greater convenience, quality of life
  • One missed dose can cause higher risk of clot
  • May have to take twice daily
  • High cost, brand only

This table compares the most common types of direct oral anticoagulants and includes links to their manufacturer’s websites for more detailed information about each drug.

Medication name Eliquis (apixaban) Xarelto (rivaroxaban) Savaysa (edoxaban) Pradaxa (dabigatran)
Administration Twice daily Once or twice daily Once daily Twice daily
Education Video Information for Patients about their Oral Anticoagulant
Manufacture Site Bristol Myers Squibb Janssen Daiichi Sankyo Boehringer Ingelheim

What to do if I think a DOAC is right for me?

If you are currently on warfarin and think a DOAC medication may be right for you, call the anticoagulation clinic to speak with one of our Anticoagulation Pharmacists at 916-734-8158. We will review your indication, potential risks, prescription insurance coverage if applicable and discuss the best steps on how to proceed.

Financial Assistance

At the UC Davis Anticoagulation Clinic, we can direct you to several cost saving methods for DOAC. If you would like to check if you qualify for payment assistance, please contact our clinic.

Anticoagulant Types

Warfarin

Warfarin is an anticoagulant that prevents new blood clots from forming and existing ones from growing larger. 
Learn more about Warfarin

Direct Oral Anticoagulants (DOAC)

Directly acting oral anticoagulants (DOAC) include a direct thrombin inhibitor (dabigatran) and factor Xa inhibitors (rivaroxaban, apixaban, and edoxaban).
Learn more about Direct Oral Anticoagulants (DOAC)

Injectable Anticoagulants

Outside the hospital, injectable anticoagulants may be used as a “bridge” for when you are starting warfarin or stopping warfarin for a short period of time.
Learn more about Injectable Anticoagulants