Choose Warfarin or a New Blood Thinner for my Blood Clot?

September 26, 2014
Submitted by By Arun Nagpaul, MD, Medical Director
Newark-Wayne Community Hospital
Contact Dr. Nagpaul at

Choose Warfarin or a New Blood Thinner for my Blood Clot?

  • FDA has recently approved three new blood thinners.
  • 500,000 people are hospitalized with blood clots each year.
  • One in every 38 people in the U.S. lives in New York City.
Dear Doc,

After returning from a shopping trip to New York City (a long car ride), I developed leg swelling and was diagnosed with a blood clot in my leg. My doctor gave me the choice of starting Coumadin (Warfarin) or one of the "newer" blood thinners. Which blood thinner should I take?

It sounds if you were diagnosed with a deep venous thrombosis (DVT). DVTs occur when a blood clot forms in a deep vein, usually in the leg or pelvis. DVTs are treated to prevent the clots from breaking off and going to the lung, a potentially life-threatening complication called a pulmonary embolism (PE). Also, blood clots in the leg if left untreated, may lead to long term leg pain and leg swelling. DVTs and PEs result in 500,000 hospitalizations per year. PEs result in almost 150,000 deaths per year. Every year more people die from preventable blood clots than from breast cancer, AIDS, and traffic accidents combined! So, it is a good thing your clot was discovered and will be treated!

Risk factors for clots include recent surgeries, cancer, smoking, obesity, a family history of clots and prolonged periods of sitting while traveling. In your case, traveling to and from NYC, one of the most interesting cities in the world.

New York City (NYC) is home to about one in every 38 people living in the US. In NYC, there are 26,000 people per square mile. In fact, NYC has more people than 39 out of the 50 U.S. states! This melting pot has the largest Chinese population outside of Asia, the largest Jewish population outside of Israel, and has the largest Puerto Rican population of any city in the world. NYC is home to Times Square, which is named after the New York Times newspaper and the Empire State Building - the 4th tallest building in the U.S. and 23rd-tallest building in the world. The Empire State building was the tallest building in the world from 1931 until 1972, the first building in the world to contain over 100 floors, and the tallest building built in the world in the 1930s. The empire state building even has its own zip code!

Coumadin, the trade name for the drug Warfarin, is the most widely prescribed oral anticoagulant (blood thinner) drug in North America. Warfarin was first introduced in 1948 as a rat poison and is still used for this purpose today. In the 1950s, warfarin was found to be safe and effective for treating blood clots and was approved for that purpose in 1954. Warfarin works well but can be tricky to take. Frequent blood tests are required to monitor how thin your blood is on Warfarin. The dose of Warfarin that is adequate to thin your blood may change frequently as a number of foods and medications may interact with Warfarin changing its effectiveness. The frequent blood draws and dosage changes can be a challenge to many of those who are prescribed Coumadin (Warfarin).

Recently the FDA has approved three new blood thinners to treat blood clots. They are prescribed under the trade names, Pradaxa, Xarelto and Eliquis. These drugs do not require blood work to monitor how thin your blood may be, therefore, patients don’t have to deal with the frequent blood draws or dosing changes that occur with Warfarin. In addition, studies show that the risk of major bleeding from the newer blood thinners is less than with Warfarin. All good news! However, a drawback to the newer blood thinners is that there is no antidote or reversing agent to the newer medications. If bleeding should occur while taking Warfarin, an antidote may be given to reverse the effects of it, limiting bleeding. The newer blood thinners have no such antidote.

The newer drugs do have some differences. Some are once a day while others are taken twice per day. Some are metabolized by the kidneys and may require dose adjustments if your kidney function is not completely normal. Your health care provider will work with you to determine the best option to thin your blood. However, the determining factor for your choice of blood thinner may be your insurance company! The newer blood thinners may cost up to $250 dollars for a 30 day supply as opposed to the $ 4 a month it costs for Warfarin. Not all insurance companies are covering the newer agents. Discuss the right blood thinner for you with your doctor.

Stay healthy and remember the quote by Lindsey Kelk, "People go to LA to 'find themselves’; they come to New York to become someone new."