If you’re experiencing severe side effects from the blood thinner warfarin, a doctor may recommend an alternative known as non-vitamin K oral anticoagulants (NOACs).

Non-vitamin K oral anticoagulants (NOACs) are a class of drugs that can treat and prevent blood clots. Also known as directly acting oral anticoagulants (DOACs), these drugs may be used as an alternative to warfarin to manage venous thromboembolism and prevent strokes in people with atrial fibrillation.

Learn more about NOACs, including the different types, uses, interactions, and alternatives.

According to a 2022 research review, NOACs were developed as alternatives to warfarin, an oral anticoagulant prescribed to treat and prevent blood clots.

NOACs target individual clotting proteins in the blood. Because these drugs have two different mechanisms of action in the body, they are grouped into two categories: direct thrombin inhibitors and direct factor Xa inhibitors.

Direct thrombin inhibitors work to block key enzymes, such as thrombin, which are responsible for blood clotting.

Direct factor Xa inhibitors are blood thinners that prevent blood clotting by blocking the action of factor Xa, a substance responsible for binding blood cells, platelets, and proteins together.

A doctor may prescribe NOACs to treat or prevent heart-related conditions.

They’re often used to treat people with chronic kidney disease (CKD) who have atrial fibrillation, as they can reduce bleeding in acute kidney injury and slow the decline of the disease.

Apixaban

Apixaban is a non-vitamin K oral anticoagulant used to treat non-valvular atrial fibrillation to lower the risk of stroke and blood clots.

The typical dosage of apixaban is 2.5 to 5 milligrams (mg) per tablet. Dosing depends on several factors, including the treatment, the person’s age, body weight, and serum creatinine.

Potential side effects of apixaban include:

Dabigatran

Dabigatran prevents and treats deep vein thrombosis (DVT) and pulmonary embolism (a blood clot in the lung). It’s also used to prevent strokes or serious blood clots in adults with AF.

Dabigatran is available in capsule​​ form and is typically taken at a dosage of 75 to 150 mg taken twice daily.

Some possible side effects of dabigatran include:

Edoxaban

Edoxaban is a NOAC that treats several heart conditions, including pulmonary embolism and DVT. It works by lowering the risk of stroke.

This non-vitamin K oral anticoagulant is given orally in 15-, 30-, and 60-mg film-coated tablets. The dosing schedule varies depending on the treatment and underlying medical conditions, but it’s typically only taken once daily.

Potential side effects of edoxaban include:

  • anemia
  • rash
  • spinal hematoma
  • angioedema (swelling in the deeper layers of skin)
  • thrombosis

According to a 2018 review, non-vitamin K oral anticoagulants can interact with other drugs and potentially increase the risk of unwanted side effects.

Below are the known drug interactions of NOACs:

  • P-glycoprotein (P-gp) inhibitors can increase the risk of bleeding when taken with NOACs.
  • P-gp (P-gp) inducers can decrease the amount of NOAC plasma concentration in the body, potentially decreasing the anticoagulant effects.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) can increase the risk of bleeding in the urinary tract, lower gastrointestinal (GI) tract, and airways when mixed with NOACs.
  • cytochrome P450 (CYP) 3A4 inhibitors can increase the amount of NOACs in the body, which may increase the risk of bleeding.
  • selective serotonin reuptake inhibitors (SSRIs) can increase the risk of bleeding if taken with NOACs.

The only alternative to NOACs is warfarin. Warfarin is an anticoagulant or blood thinner and is considered the first-line treatment for treating and preventing blood clots. The drug is approved by the Food and Drug Administration (FDA) for preventing and treating venous thrombosis and arising pulmonary embolism, heart attacks, and atrial fibrillation.

According to a 2017 study, people typically take NOACs because they’re an effective and much safer alternative to warfarin. This is because there’s a lower risk of side effects and fewer drug interactions with NOACs.

Non-vitamin K oral anticoagulants (NOACs) are blood thinners prescribed to treat or prevent various heart conditions, including atrial fibrillation and venous thromboembolism.

They’re often seen as safer alternatives to the blood thinner warfarin, as this first-line treatment is linked to more serious side effects and drug interactions.