Old and new oral anticoagulants: Food, herbal medicines and drug interactions

Blood Rev. 2017 Jul;31(4):193-203. doi: 10.1016/j.blre.2017.02.001. Epub 2017 Feb 5.


The most commonly prescribed oral anticoagulants worldwide are the vitamin K antagonists (VKAs) such as warfarin. Factors affecting the pharmacokinetics of VKAs are important because deviations from their narrow therapeutic window can result in bleedings due to over-anticoagulation or thrombosis because of under-anticoagulation. In addition to pharmacodynamic interactions (e.g., augmented bleeding risk for concomitant use of NSAIDs), interactions with drugs, foods, herbs, and over-the-counter medications may affect the risk/benefit ratio of VKAs. Direct oral anticoagulants (DOACs) including Factor Xa inhibitors (rivaroxaban, apixaban and edoxaban) and thrombin inhibitor (dabigatran) are poised to replace warfarin. Phase-3 studies and real-world evaluations have established that the safety profile of DOACs is superior to those of VKAs. However, some pharmacokinetic and pharmacodynamic interactions are expected. Herein we present a critical review of VKAs and DOACs with focus on their potential for interactions with drugs, foods, herbs and over-the-counter medications.

Keywords: Co-morbidities; Direct anticoagulant drugs; Loss of efficacy; Patients characteristics; Therapeutic context; Thrombotic/bleeding events; Toxicity; Warfarin.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Anticoagulants / chemistry
  • Anticoagulants / pharmacokinetics
  • Anticoagulants / pharmacology*
  • Anticoagulants / therapeutic use
  • Drug Interactions*
  • Food-Drug Interactions
  • Herbal Medicine / methods
  • Humans
  • Plant Extracts / chemistry
  • Plant Extracts / pharmacokinetics
  • Plant Extracts / pharmacology*
  • Plant Extracts / therapeutic use
  • Plants, Medicinal / chemistry
  • Vitamin K / antagonists & inhibitors


  • Anticoagulants
  • Plant Extracts
  • Vitamin K