Mayo Clinic Talks Vascular Medicine Series: How to Choose Your Anticoagulant
Sep 9, 2025
Ana I. Casanegra, a vascular medicine specialist at the Mayo Clinic, discusses the exciting shift from traditional warfarin to newer direct oral anticoagulants (DOACs). She highlights why some patients still benefit from warfarin, addressing factors like efficacy and cost. The conversation dives into the necessary lab evaluations before starting therapy, emphasizing safety in anticoagulant management. Casanegra also explores the complexities of tailoring treatment to individual needs, particularly for the elderly.
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How DOACs Work And Why They Differ
- DOACs directly inhibit single clotting factors and have predictable pharmacokinetics without dietary issues.
- This predictability removes routine monitoring and many interactions compared to warfarin.
When To Keep Using Warfarin
- Prefer warfarin for mechanical heart valves and high‑risk antiphospholipid syndrome as DOACs performed worse.
- Consider cost and access because DOACs may be unaffordable for some patients.
DOACs Still Interact With Key Drugs
- DOACs have fewer drug interactions than warfarin but important ones remain, especially with anticonvulsants and azole antifungals.
- Interacting drugs can either lower DOAC levels (risking thrombosis) or raise them (risking bleeding).