Warfarin alternative on the horizon

If you're one of the thousands of Americans who takes warfarin (brand name Coumadin), you'll know it comes with drawbacks.

Warfarin is used to thin the blood, in order to prevent blood clots that can cause strokes. Lots of people take warfarin, including people who have an irregular heartbeat (atrial fibrillation), a disorder that can increase your risk of getting blood clots.

However, the effects of warfarin are not very predictable, so you need to get your blood tested regularly to check that it's not getting too thin. If your blood is too thin, you bleed easily. This can lead to a different type of stroke, caused by bleeding in the brain.

Not only that, but you also have to be careful about what you eat and drink, and which other medications you take. Alcoholic drinks, grapefruit juice, and nonsteroidal anti-inflammatory painkillers (e.g., ibuprofen) all react with warfarin to make it stronger. So doctors have been searching for many years for a medication to replace warfarin. They may now have found one that works as well as warfarin, but without warfarin's drawbacks. The drug dabigatran is used already to help prevent blood clots in people having orthopedic surgery (such as hip or knee joint replacements). A study of people with atrial fibrillation showed that it worked at least as well as warfarin to prevent strokes.

The company that makes the drug now has to apply to the FDA for licensing approval to market dabigatran for stroke prevention. People taking warfarin, and their doctors, may then have an alternative drug to turn to. However, it will likely be more expensive than warfarin, which has been in use for many years. So for many people, the question will be whether the convenience of the newer drug is worth the increased cost.

What you need to know. Dabigatran, an anti-clotting medication, may be a useful substitute for warfarin for people with atrial fibrillation. But it has yet to be granted a license by the FDA, and it's likely to be more expensive than the existing treatment.

—Anna Sayburn, patient editor, BMJ Group

ConsumerReportsHealth.org has partnered with The BMJ Group (British Medical Journal) to monitor the latest medical research and assess the evidence to help you decide which news you should use.

Read more about the things that can increase your risk of atrial fibrillation and read the evidence for warfarin in treating atrial fibrillation (subscribers only).