Is there room for warfarin in clinical management? Narrative literature review

Abstract

Introduction: Anticoagulation is essential for the prevention of thromboembolic events. Warfarin, although widely used and effective, requires frequent monitoring and presents various interactions that complicate management. Direct oral anticoagulants (DOACs) have emerged as simpler alternatives in several scenarios, despite their higher cost. This study compares warfarin and DOACs regarding indications, efficacy, safety, and impact on quality of life. Objective: Thromboembolic disorders require effective anticoagulation to prevent serious complications, with warfarin and DOACs being the main therapeutic options. This study aims to review the medical literature on the indications for warfarin use compared to direct oral anticoagulants (DOACs). Method: Narrative literature review, with a search in the PubMed database using the descriptors “warfarin,” “anticoagulants,” and “direct oral anticoagulants,” applying filters for clinical trials from 2016 to 2024. Twenty-three articles comparing warfarin and DOACs clinically were included. Results: Most studies reported similar efficacy between warfarin and DOACs in conditions such as venous thrombosis, atrial fibrillation, and left ventricular thrombus. DOACs demonstrated a lower risk of bleeding, especially intracranial, and greater convenience as they do not require INR monitoring. Discussion: Although DOACs offer advantages, warfarin remains preferred in specific populations, such as patients with mechanical valves and antiphospholipid syndrome. Further studies are needed to better define its use.