Patient education: How to take anticoagulants safely (The Basics)

What are anticoagulants? — 

These are medicines that decrease blood clotting. They are used to:

●Keep clots from growing bigger and blocking blood vessels

●Help prevent new clots from forming

Preventing clots is important because it lowers the chances of serious problems like blood clots in the lungs, strokes, and heart attacks.

Anticoagulants are also sometimes called "blood thinners." But they do not actually thin the blood.

Many anticoagulants are oral medicines. They come as pills or capsules you take by mouth. Examples include:

●Apixaban (brand name: Eliquis)

●Dabigatran (brand name: Pradaxa)

●Edoxaban (brand names: Savaysa, Lixiana)

●Rivaroxaban (brand name: Xarelto)

●Warfarin (brand name: Jantoven, also called Coumadin in some places)

In some cases, doctors prescribe an anticoagulant that comes as an injection (shot) instead.

How do I safely take my anticoagulant? — 

The medicine comes with information and instructions. Read these carefully.

●General tips – It's important to:

•Make sure you know the strength of your medicine and what it looks like.

•Know how to store the medicine safely away from heat and out of children's reach.

•Ask your doctor, nurse, or pharmacist if you have any questions. If you take warfarin, you might work with an "anticoagulation clinic."

●Being prepared – Always wear a bracelet, necklace, or alert tag that says you take an anticoagulant and the name of the medicine. You can also carry a wallet card or put this information into your cell phone, along with the name and number of an emergency contact person. This way, if you are ever in an accident and are unable to explain your condition, people will know how to care for you.

●Blood tests – If you take warfarin, you need regular blood tests to check if your blood is clotting well. The test is called "PT and INR." Depending on the results, you might change your dose or skip a dose until your result is in the best range.

You do not need regular blood tests for the other oral anticoagulants. But you might occasionally need a blood test to check your kidney and liver function.

●Taking other medicines – Ask your doctor, pharmacist, or anticoagulation clinic before taking any new medicines. This includes prescription or over-the-counter medicines, herbs, supplements, and vitamins. Some of these can change the way anticoagulants work (table 1).

If another doctor prescribes a new medicine, such as an antibiotic, tell your doctor or anticoagulation clinic. If you take warfarin, you might need a blood test and the warfarin dose might need to be adjusted while you are taking the other medicine.

●Diet – For most anticoagulants, there are a few rules about diet. For some, like apixaban or rivaroxaban, do not drink a lot of grapefruit juice.

If you take warfarin, foods that contain a lot of vitamin K can affect how it works. Many foods that are high in vitamin K, like leafy greens, broccoli, and kale, are an important part of a healthy diet. Do not avoid healthy foods that contain vitamin K. Just make sure you eat about the same amount of these foods every day. The table lists the amount of vitamin K in different kinds of foods (table 2).

There are no special rules about diet if you take anticoagulant shots.

●Vitamin K supplements – If you take warfarin, do not take extra vitamin K unless your doctor tells you to. Vitamin K is in some other vitamins, supplements, and calcium products.

●Pregnancy – If you want to get pregnant, talk to your doctor about how this will affect your anticoagulant. Oral anticoagulants are not recommended during pregnancy. Warfarin can cause problems with a baby's development, especially early in the pregnancy. Most people switch to an anticoagulant that is given as a shot.

Tell your doctor right away if you do get pregnant while taking an oral anticoagulant. They will work with you to make a plan. Do not stop taking the anticoagulant without talking to your doctor or nurse.

If you do not want to get pregnant, your doctor can also talk to you about birth control options.

How can I lower my risk of bleeding? — 

The main risk with anticoagulants is bleeding. Serious bleeding is not common, but it can happen. Bleeding can happen after an injury, but it can also happen without an injury.

There are things you can do to lower your risk of serious bleeding.

Plan:

●Talk with your doctor so you have a plan for what to do if you:

•Accidentally miss a dose of your medicine or take an extra dose

•Get sick or cannot take your medicine

•Need to have surgery or a dental procedure

•Have abnormal bleeding

•Might get pregnant

●If you need surgery or a procedure, make sure the doctors treating you know you are taking an anticoagulant. Talk to your doctor to find out when you should stop and restart your anticoagulant.

●If you are having a dental procedure, tell the dentist or oral surgeon you are taking an anticoagulant. Their directions about your anticoagulant depend on the procedure.

Avoid injuries:

●Avoid doing things that could lead to a fall. Examples include walking on slippery surfaces or climbing on a high stool or ladder.

●Avoid sports that might cause injury.

●Use care when handling sharp tools that could cut you, or avoid them when possible. Examples include sharp knives, saws, and straight-edge razors.

Protect yourself:

●Always wear a seatbelt in the car, whether you are the driver or a passenger.

●Always wear a helmet if you ride a bicycle or motorcycle.

●Avoid drinking a lot of alcohol. If you do drink, limit yourself to 1 to 2 servings per day or less. A serving is equal to 1 beer (12 ounces), 1 glass of wine (5 ounces), or 1 shot of liquor (1.5 ounces).

●If you get nosebleeds, use a humidifier when the air is dry. You can also try putting petroleum jelly (Vaseline) in your nose. Do not pick your nose.

●Avoid medicines that increase your risk of bleeding, unless your doctor tells you to take them. For example, "NSAIDs" like ibuprofen (sample brand names: Motrin, Advil), naproxen (sample brand name: Aleve), and aspirin can increase the risk of bleeding. For treating fever or minor aches and pains, you can take acetaminophen (sample brand name: Tylenol).

How do I stop bleeding if it does happen? — 

See the table (table 3) for things you can do.

When should I call for help? — 

Get emergency help right away (in the US and Canada, call 9-1-1) if you:

●Fall, hit your head, or get another serious injury that could cause bleeding

●Are in a car accident

●Have a severe headache or pass out

●Have trouble talking, weakness, or loss of function in your arm or leg

●Vomit blood or something that looks like coffee grounds

●Have severe bleeding

Call your doctor right away if you have any of these signs of abnormal bleeding:

●Bowel movements that look dark black or tarry

●Nosebleeds or any bleeding that does not stop with the advice in the table (table 3)

●Heavy menstrual periods or bleeding between periods

●Dark red or brown urine

You should also tell your doctor if you:

●Took more medicine than you were supposed to

●Bleed from your gums after brushing your teeth

●Have more bruising than usual after a minor injury

●Have diarrhea, vomit, or cannot eat or drink for more than 24 hours

●Have a fever (temperature higher than 100.4°F, or 38°C)

●Cannot take your medicine for any reason, or miss 1 or more doses

For more detailed information about your medicines, ask your doctor or pharmacist for the patient drug information handout from UpToDate. It explains how to use each medicine, describes its possible side effects, and lists other medicines or foods that can affect how it works.

More on this topic

Patient education: Anticoagulant medicines – Uses and kinds (The Basics)
Patient education: Lowering the risk of a blood clot (The Basics)
Patient education: Managing increased bleeding risk (The Basics)
Patient education: Deep vein thrombosis (blood clot in the leg) (The Basics)
Patient education: Deep vein thrombosis (blood clot in the arm) (The Basics)
Patient education: Pulmonary embolism (blood clot in the lung) (The Basics)
Patient education: Atrial fibrillation (The Basics)
Patient education: Medicines for atrial fibrillation (The Basics)
Patient education: Stroke (The Basics)
Patient education: Heart attack (The Basics)
Patient education: Prosthetic valves (The Basics)
Patient education: Prothrombin time and INR (PT/INR) (The Basics)
Patient education: Warfarin and your diet (The Basics)
Patient education: Coping with high drug prices (The Basics)

Patient education: Warfarin (Beyond the Basics)
Patient education: Deep vein thrombosis (DVT) (Beyond the Basics)
Patient education: Pulmonary embolism (Beyond the Basics)
Patient education: Atrial fibrillation (Beyond the Basics)
Patient education: Heart attack (Beyond the Basics)
Patient education: Coping with high prescription drug prices in the United States (Beyond the Basics)