Coumadin

Analyst Outlook

Coumadin (warfarin; Bristol-Myers Squibb) is likely to remain the standard of care for the treatment

of venous thromboembolism (VTE). The drug’s favorable pricing regimen and the availability of a

reversal agent will facilitate its adoption among patients and physicians, with uptake expected to be

especially high in patients who are not suitable for a novel oral anticoagulant (NOAC) regimen.

However, Coumadin is likely to face strong competition from the NOAC drug class in the wider VTE

market; these drugs have demonstrated superior efficacy and safety to Coumadin, along with more

convenient dosing regimens, which could limit Coumadin’s future uptake in the market.

Drug Overview

Coumadin is an orally available vitamin K antagonist (VKA) indicated for the prophylaxis and

treatment of deep vein thrombosis and pulmonary embolism. The drug inhibits the synthesis of

vitamin K-dependent clotting factors such as factors II, VII, IX, and X, and the anticoagulant proteins

C and S. It interferes with clotting factor synthesis by inhibiting the vitamin K epoxide reductase

complex, subunit 1 enzyme, thereby reducing the regeneration of vitamin K1 epoxide, which

ultimately inhibits vitamin K regeneration (FDA, 2011).