Free Nursing Pharmacology Review Course – DOACs and Warfarin – Section 2.6

Direct oral anticoagulants (DOACs) and warfarin serve as primary therapeutic options for anticoagulation, each presenting distinct clinical profiles. DOACs, such as apixaban and rivaroxaban, primarily inhibit Factor Xa, providing a more predictable dosing regimen with fewer drug interactions and no requirement for routine INR monitoring. Conversely, warfarin remains the standard for patients with prosthetic heart valves and those requiring cost-effective long-term management, despite the necessity for frequent INR checks and strict dietary vitamin K regulation. Both drug classes carry a significant risk of bleeding, which is exacerbated by the concurrent use of NSAIDs or antiplatelet agents. Clinical selection hinges on patient stability, renal function, and the specific indication, as warfarin requires a slower onset of action and more intensive monitoring to maintain a therapeutic INR range of 2 to 3.