Class Explorer · Hematology
Anticoagulants
Interrupt the coagulation cascade: warfarin starves factor synthesis upstream; DOACs inhibit factor Xa or thrombin directly.
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WarfarinThe vitamin K antagonist: ancient, cheap, measurable, and demanding.ApixabanThe direct factor Xa inhibitor that made anticoagulation boring. In a good way.RivaroxabanA once-daily factor Xa inhibitor whose dose depends on what you are treating.EnoxaparinThe injectable bridge: predictable, weight-based, and kidney-dependent.
Also in this class: Rivaroxaban (Xa, once daily with food) · Edoxaban (Xa) · Dabigatran (IIa, dyspepsia, idarucizumab) · Heparins (parenteral, AT-mediated). Full pages arrive as the library grows.
Compare the members
Warfarin
- Target
- VKORC1 (II, VII, IX, X)
- Monitoring
- INR
- Renal reliance
- Minimal
Apixaban
- Target
- Factor Xa
- Monitoring
- Renal function, adherence
- Renal reliance
- ~27%
Rivaroxaban
- Target
- Factor Xa
- Monitoring
- None routine
- Renal reliance
- Contraindicated at low clearance
Enoxaparin
- Target
- Factor Xa mainly, via antithrombin
- Monitoring
- Anti-Xa in selected patients
- Renal reliance
- Dose reduced below 30 mL/min
Shared across the class
- Indications
- Stroke prevention in AF · VTE treatment and prevention · Mechanical valves (warfarin only)
- Adverse effects
- Bleeding: the class effect that defines all counselling
- Contraindications
- Active major bleeding
- Monitoring
- Warfarin: INR · DOACs: renal function at least annually · All: bleeding signs, adherence, procedures
What makes each agent different
- Monitoring: warfarin is INR-run; DOACs are fixed-dose with renal-function surveillance instead.
- Onset/offset: DOACs act within hours and fade within a day or two; warfarin takes days each way.
- Territory warfarin keeps: mechanical valves, antiphospholipid syndrome, severe renal failure (jurisdiction-dependent).
- Reversal: vitamin K + PCC for warfarin; idarucizumab (dabigatran) and andexanet (Xa) where available.
The DOAC's freedom from INR checks silently removes the adherence check that came with them. Ask on purpose.
Last reviewed 2026-08-15 · Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed.