Anticoagulants overview: warfarin vs heparin vs DOACs
Side-by-side comparison of the three anticoagulant classes, when to use each, monitoring, antidotes.
Three classes, different jobs. Quick reference for NCLEX.
Warfarin
Oral. Slow onset (3-5 days). Monitor INR (2-3). Antidote: vitamin K. Pregnancy contraindicated. Mechanical valves: warfarin still standard.
Heparin (UFH)
IV or SQ. Fast onset. Monitor aPTT (60-80s) for IV; not needed for SQ prophylaxis. Antidote: protamine. HIT risk.
LMWH (enoxaparin)
SQ. No routine monitoring. Partial protamine reversal.
DOACs (apixaban, rivaroxaban, dabigatran)
Oral. No routine monitoring. Specific antidotes (Andexxa, Praxbind). Not for mechanical valves.
When each is used
Acute inpatient: heparin drip. Bridge: LMWH. Long-term AFib/DVT: DOAC or warfarin (mechanical valves: warfarin only).
Frequently asked
Bridging anticoagulation, when?
Mechanical valves, recent stroke, AFib with high CHA2DS2-VASc going off warfarin for surgery.
Pregnancy?
Heparin or LMWH only. Warfarin and DOACs contraindicated.
Quick check
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