Overview

Anticoagulants are medicines that thin your blood and stop if from clotting as quickly. They might be prescribed for you if you are diagnosed with:

• blood clots (deep vein thrombosis or pulmonary embolism) or
• atrial fibrillation (an irregular heart rhythm)

If you have atrial fibrillation, you are at a higher risk of getting blood clots in the brain and a stroke. Anticoagulants reduce this risk by preventing your blood from clotting as quickly as normal.

If you have a pulmonary embolism (PE) or deep vein thrombosis (DVT), an anticoagulant prevents the clot from getting larger or new clots from forming.

Warfarin is a type of anticoagulant that has been used to treat clots for many years, but you need regular blood tests.

Direct oral anticoagulants (DOACs) can be used instead of warfarin. You take a fixed amount (dose) of them. This means that you do not need regular blood tests.

What DOACs can be taken for

DOACs can be taken instead of warfarin to treat:

• atrial fibrillation (AF), which is an irregular heart rhythm
• deep vein thrombosis (DVT), which is a blood clot in a deep vein (usually in your leg)
• pulmonary embolism (PE), which is a blood clot in a blood vessel of your lungs

How long to take a DOAC

How long you take the medicine depends on your condition.

Your doctor discusses this with you and confirms how long you need to continue your treatment.

For DVT or pulmonary embolism

• If this is your first DVT or PE, you usually take a DOAC for 3 to 6 months.
• For recurrent blood clots, you might have long-term DOAC treatment.

For atrial fibrilation

If you have AF, you usually take a DOAC long term.

How to take the medicine

How you take the medicine, and how often, depends on the DOAC that you have been prescribed. Each medicine comes in different strengths and doses.

DOACs that you might take include:

• apixaban
• edoxaban
• rivaroxaban
• dabigatran

Please follow the dosage instructions given by your doctor, nurse or pharmacist. Your medicine box is labelled with the correct dosage for you. You need to take your medicine at the same time every day, with or after food if advised.

Always read the leaflet that comes with your medicine. Speak to your doctor or pharmacist if you have any questions.

If you forget to take your medicine

If you miss a dose, take it as soon as you remember.

Do not double up on the total daily dose.

Please look at the information leaflet with your medicine for specific details. You can also call our pharmacy medicines helpline for advice on 020 7188 8748 from 9am to 5pm, Monday to Friday.

Side effects

Bleeding is the most common side effect of DOACs because they increase the time it takes for your blood to clot.

Get medical advice immediately if you:

• hit your head or were involved in an accident
• have long-lasting nosebleeds (over 10 minutes)
• have blood in your urine or poo (including black, tar-like poo)
• vomit blood
• have unexplained or severe bruising or bleeding

If you have bleeding from a wound, apply pressure to the wound.

If the bleeding does not stop within 10 minutes, go to the emergency department (A&E).

We recommend that you carry an anticoagulation card with you at all times, in case of emergency. If you do not have the card, please ask your pharmacist for one.

Heavy periods

It's common to have heavier or longer periods while taking anticoagulation. If you notice your periods are becoming heavier, or unmanageable, or you feel increasingly tired or anaemic, please contact the team that prescribes your DOACs. There are things we can do to manage this, and we do not recommend stopping your treatment without speaking to the healthcare team.

Your other medicines

Your doctor reviews your medicines when you are first prescribed a DOAC and makes any necessary changes.

Some medicines do not mix well with DOACS. These can include:

• vitamin supplements
• herbal remedies
• other medicines that you buy from a pharmacy or shop

It is important that you:

• check with a pharmacist before starting or stopping any medicines
• avoid taking any other medicines that may increase your risk of bleeding (such as aspirin or ibuprofen), unless your doctor specifically prescribes them for you

If you need painkillers, paracetamol and codeine are OK.

You need to tell other healthcare professionals who look after you that you take a DOAC. This includes anyone who prescribes you medicines, reviews your medicines or does a procedure, such as a dentist.

Diet and alcohol

You do not need to change what you eat when taking a DOAC. It is important to keep a healthy and balanced diet.

Alcohol does not directly affect DOACs. We recommend that you do not drink more than the safe limits of alcohol (14 units each week). Drinking too much alcohol can increase your risk of bleeding.

If you are pregnant

Tell your doctor straight away if you become pregnant. You then need to change to a different medicine.

Follow-up appointments

Soon after starting treatment, you might have a hospital appointment. This is to make sure that you do not have any problems with your new medicine.

• If you have atrial fibrillation, you see a cardiologist (heart specialist) or haematologist (blood specialist) and might visit our anticoagulation clinic. The hospital provides you with the first month’s supply of medicine. After this your GP should prescribe this for you.
• If you have DVT or pulmonary embolism, a thrombosis specialist at St Thomas' Hospital sees you. The hospital provides you with the first 3 months of medicine. After this your GP should prescribe this for you. It is important you do not stop taking the medicine unless a doctor tells you it is safe to stop.

Your GP orders routine tests at least once a year. These tests check if your kidneys work well and if you have any side effects.

Useful sources of information

The MedTap app allows patient and carers to watch short videos, which give similar information to that discussed during consultations.

We recommend that you always carry an anticoagulant card with you in case of emergency. If you do not already have the card, please ask your pharmacist for one.

Always speak to a doctor before you stop taking your medicine.