Factor Xa inhibitors are newer anticoagulants that offer some advantages over older ones. The biggest advantage is that people taking them don’t need frequent blood tests. People take factor Xa inhibitors to prevent or treat blood clots. They can take them for days or months, depending on the situation.
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Factor Xa inhibitors are drugs that keep your blood from clotting too much. Sometimes, people call them “blood thinners.” Healthcare providers call these medicines direct oral anticoagulants (DOACs). You can take them when you need to treat a blood clot and also as a long-term medicine to prevent blood clots.
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Factor Xa inhibitor drugs include:
Factor Xa inhibitors can:
Some people may take factor Xa inhibitors because they already have a blood clot. Others may take them because they may be at risk of a blood clot. This group includes people who:
More than 3.7 million Americans on Medicare take factor Xa inhibitors, according to 2020 numbers from the Centers for Medicare & Medicaid Services.
Factor Xa inhibitors have become a popular choice for people who need to take an anticoagulant. Before factor Xa inhibitors, many people took warfarin (Coumadin® or Jantoven®). Warfarin is an effective medication that healthcare providers have prescribed for many years.
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However, your provider has to adjust your dose based on the results of regular blood tests that check how long it takes your blood to clot. You may need to take these tests anywhere from once a month to twice a week.
Frequent blood testing with warfarin is the major difference between warfarin and a factor Xa inhibitor.
Factor Xa inhibitors get in the way of a protein your body needs to make blood clots. Making a clot takes various steps. By keeping factor Xa from doing its part in the process, it’s like taking someone out of the assembly line. You slow down the clotting.
The reason you’re taking factor Xa inhibitors determines how long you’ll need to take them. If you have atrial fibrillation, you may need to be on a factor Xa inhibitor for life.
If you have venous thromboembolism (VTE), you’ll need to take a factor Xa inhibitor for three to six months. For deep vein thrombosis (DVT) or a pulmonary embolism (PE), you’ll take it for six months.
If you’re having knee replacement surgery, you’ll only need to take a factor Xa inhibitor for 12 days afterward. You take them for 35 days after a hip replacement.
Factor Xa inhibitors provide these benefits:
Multiple studies have shown that factor Xa inhibitors work as well as or better than older drugs that prevent dangerous blood clots. Also, people taking factor Xa inhibitors have fewer bleeding episodes.
You’re at risk of bleeding in your brain and digestive system while taking factor Xa inhibitors. It can be hard for people to control this bleeding. Also, factor Xa inhibitors — and drugs to reverse their effects — are more expensive than medicines that existed years earlier.
A different drug, andexanet alfa, can reverse the effects of some factor Xa inhibitors. Providers use this if your bleeding is uncontrollable or life-threatening.
All anticoagulants carry some risk of bleeding because they interfere with your blood clotting process.
Other factor Xa inhibitor side effects may include:
Factor Xa inhibitors begin to take effect in a few hours, so you should feel better the same day.
Because a factor Xa inhibitor can make you bleed more than you normally would without it, try to avoid getting hurt. Try these tips:
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Contact your healthcare provider if you experience:
A note from Cleveland Clinic
Factor Xa inhibitors have freed many people from the need for frequent blood testing. However, they may not be a good choice for you. Talk with your healthcare provider about your situation to understand your options. Whichever anticoagulant you take, be sure to follow your provider’s instructions carefully. Ask questions if there’s something you don’t understand about how your medicine works.
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Last reviewed on 02/18/2023.
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