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Key takeaways
Entresto is a combination heart medication that’s FDA approved to treat heart failure, but is not a blood thinner.
It contains sacubitril and valsartan, which work to relax blood vessels and increase blood flow. However, it doesn’t treat or prevent blood clots.
Because it’s an expensive heart medication with a familiar-sounding name, some people mistake it for a blood thinner, even though it has no anticoagulant benefits.
Entresto is a brand-name prescription medication containing two different drugs, sacubitril and valsartan, and is approved to treat chronic heart failure. Because it is prescribed to treat heart conditions, some people confuse Entresto for a blood thinner. However, it’s important to know the difference between your heart medications and understand why your provider has prescribed you Entresto.
Is Entresto a blood thinner?
No, Entresto is not a blood thinner. It’s approved by the Food and Drug Administration to treat chronic heart failure in adults and symptomatic heart failure in children over 1 year old. It works especially well for people whose hearts don’t pump enough blood on their own, a measurement known as ejection fraction (EF).
Entresto is part of a class of drugs called angiotensin receptor-neprilysin inhibitors (ARNIs). It’s a combination medication containing sacubitril (a neprilysin inhibitor) and valsartan (an angiotensin II receptor blocker, or ARB). Blood thinners, or anticoagulants, are a separate class of drugs and include medications like warfarin, Eliquis (apixaban), and Xarelto (rivaroxaban). They don’t actually make your blood thinner, but prevent your blood from forming potentially dangerous clots.
RELATED: Entresto generic availability, cost, and dosage
How does Entresto work?
Because it contains two drugs, Entresto works for people with chronic heart failure in multiple ways. According to Joyce Oen-Hsiao, MD, associate professor of medicine at Yale School of Medicine:
- Sacubitril prevents the breakdown of natriuretic peptides, which helps relax blood vessels and promote sodium excretion.
- Valsartan inhibits the effects of angiotensin II, a hormone that causes blood vessels to constrict and increases blood pressure.
Together, sacubitril and valsartan work to provide the following benefits:
- Relax blood vessels and increase blood flow
- Control blood volume
- Reduce strain on the heart
- Lower blood pressure
- Reduce the production of hormones that cause sodium and fluid retention
Valsartan can also prevent remodeling of the heart (i.e., structural changes to the heart’s size, shape, and functioning), which would normally lead to worsening heart function and heart failure, per Dr. Oen-Hsiao. However, nothing about Entresto’s mechanism of action provides any blood-thinning or anticoagulant benefits.
“Anticoagulants target different enzymes in the blood clotting cascade to thin out the blood inside the vessel,” says Joanna Lewis, Pharm.D., founder of The Pharmacist’s Guide.
Why do people think Entresto is a blood thinner?
There are a few reasons why Entresto may be mistaken for a blood thinner. For starters, ARNIs and anticoagulants are both heart medications that can be expensive and often require prior authorization for insurance coverage, Dr. Oen-Hsiao explains.
If you are taking multiple medications to treat heart problems, it can be easy to forget why you’ve been prescribed each drug or what it does for your body. This is especially true for people who are taking both Eliquis and Entresto, says Dr. Lewis: “Eliquis and Entresto have similar-sounding names, which can be confusing to patients since both medications are heart-related.”
Dr. Lewis adds that people may also confuse or mix up these medications based on their appearance, since, depending on the dosage strength or manufacturer, some pills have similar packaging and shapes.
Who is Entresto for?
Entresto is for people with heart failure, especially reduced ejection fraction (HFrEF). It’s not for people with clotting disorders or who are at risk for blood clots, because it doesn’t provide any anticoagulant benefits.
Entresto isn’t safe for everyone, and some people with heart failure should not take it because of an increased risk of side effects, illness, or injury. According to Dr. Oen-Hsiao, this includes:
- People with a history of facial swelling in response to ARBs like valsartan, or angiotensin-converting enzyme (ACE) inhibitors like Zestril (lisinopril) and Epaned (enalapril)
- People with severe kidney or liver disease
- People with diabetes who also take Tekturna (aliskiren) for high blood pressure
Additionally, Dr. Oen-Hsiao notes that some people should take Entresto cautiously, including people:
- With a history of elevated potassium levels
- Taking Aldactone (spironolactone) or Inspra (eplerenone)
- Taking lithium
- Taking regular or high doses of NSAIDs like ibuprofen
If you can’t take Entresto safely, talk to your healthcare providers about possible Entresto alternatives, like Coreg (carvedilol) and Farxiga (dapagliflozin).
Side effects of Entresto
Even people who can safely take Entresto for heart failure may experience side effects from this medication. Common side effects include low blood pressure, dizziness, diarrhea, joint and back pain, and high blood levels of potassium. Contact your healthcare provider if side effects affect your daily life, but get emergency medical attention if you experience symptoms of an allergic reaction, like facial or oral swelling or shortness of breath.
Bottom line: Entresto is not an anticoagulant
Entresto is a heart medication used to treat chronic heart failure, but it’s not a blood thinner. It relaxes your blood vessels and promotes better blood flow, reducing strain on your heart.
Although Entresto is sometimes confused for a blood thinner, it won’t prevent or treat blood clots or clotting disorders. It’s important to understand exactly which medications you take and why you take them; this helps you manage your medications correctly. It’s also important to inform your healthcare providers about the drugs you take. If you have questions about the medications you’re taking or what purpose they serve, ask your healthcare provider or pharmacist for help.
- Entresto highlights of prescribing information, Food and Drug Administration (2024)
- Ejection fraction heart failure measurement, American Heart Association (2025)
- Valsartan and sacubitril, MedlinePlus (2024)
- A new mechanism of action in heart failure, Journal of Pharmacy Technology (2015)
- Cardiac remodeling: Concepts, clinical impact, pathophysiological mechanisms and pharmacologic treatment, Arquivos Brasileiros de Cardiologia (2016)