Anticoagulant Medicines

Your doctor or nurse should tell you how much of your anticoagulant medicine to take and when to take it. 

If you're unsure how to take your medicine, check the patient information leaflet that comes with it or ask your anticoagulant clinic, GP or pharmacist what to do. You can also call NHS 111 for advice.

About your anticoagulant dose

For most people, anticoagulant tablets or capsules should be taken at the same time once or twice a day. It's important to take your medicine as scheduled because the effect of some anticoagulants can start to wear off within a day.

Warfarin, apixaban (Eliquis) and dabigatran (Pradaxa) should be taken with water. Rivaroxaban (Xarelto) is normally taken with food.

Depending on your dose, you may need to take more than one tablet or capsule at a time.

Warfarin tablets come in different colours (white, brown, blue and pink) to indicate their strength. You may need to take a combination of different coloured tablets to reach your total dose. Other anticoagulants come in different strengths and colours.

Your doctor or nurse will explain how many tablets you need to take, when to take them, and what the different colours mean.

Missed or extra doses

Warfarin

If you're taking warfarin and you miss one of your doses, you should skip the dose you missed and wait to take your next scheduled dose as normal. Don't take a double dose to make up for the one you missed.

If you accidentally take a dose that was much higher than recommended, contact your anticoagulant clinic or GP for advice.

Newer anticoagulants

If you're taking apixaban or dabigatran twice a day and you miss one of your doses, you should take it as soon as you remember if it's still more than six hours until your next scheduled dose. If it's less than six hours until your next dose, skip the dose you missed and take the next scheduled dose as normal.

If you accidentally take a double dose, skip your next scheduled dose and take the following dose the next day as scheduled.

If you're taking rivaroxaban once a day and you miss one of your doses, you should take it as soon as you remember if it's still more than 12 hours until your next scheduled dose. If it's less than 12 hours until your next dose, skip the dose you missed and take the next scheduled dose as normal.

If you accidentally take a double dose, take your next dose the next day as scheduled.

Monitoring your dose

Warfarin

If you're taking warfarin, you will need regular blood tests to check how quickly your blood clots. This is measured using the international normalisation ratio (INR).

Your INR will be regularly tested at your GP surgery or anticoagulant clinic to make sure your blood doesn't clot too slowly or too quickly. Your warfarin dose will be adjusted until your INR is in the correct range.

Your INR may need to be tested every other day at first until you're on the right dose. Once your INR stabilises in the correct range, these tests will be needed less frequently.

There are now home testing kits to monitor your INR. These mean you don't need to go to your GP surgery or anticoagulant clinic for the INR test. This kit may be useful for some people, but you'll need training to use it and you'll usually need to pay for one yourself.

Speak to your doctor or nurse if you're considering using a home testing kit.

Newer anticoagulants

If you're taking apixaban, dabigatran or rivaroxaban, you won't need to have regular blood tests to monitor your INR.

However, you should still have appointments every few months to check you're taking your medication correctly and to discuss whether you've experienced any side effects.

If you're prescribed anticoagulants, always follow the instructions of your GP or other healthcare professional.

Some of the main issues you'll need to consider while taking your medication are outlined below.

Having surgery

If you're taking anticoagulants and you need to have surgery or any kind of invasive procedure, make sure that the healthcare professionals treating you are aware of your medication. This includes procedures used to diagnose other conditions, such as an endoscopy or cystoscopy.

As anticoagulants reduce the ability of your blood to clot, there's a risk you could experience heavy bleeding if any kind of cut (incision) is made during a procedure. You may therefore be advised to stop taking your medication before surgery.

If you're having a dental procedure, such as having a tooth removed, tell your dentist that you take anticoagulants. You may not need to stop taking your medication, but you might need to have a blood test before the procedure to make sure your blood clots at the right speed.

Only stop taking your medication on the advice of your GP or another healthcare professional.

Pregnancy

Warfarin isn’t normally given to pregnant women because it can affect the unborn baby. This can cause birth defects or excessive bleeding from the placenta or foetus.

It may sometimes be used in the second trimester, but should never be taken during the first trimester and should ideally be avoided in the third trimester as well.

The newer anticoagulant medications apixaban (Eliquis), dabigatran (Pradaxa) and rivaroxaban (Xarelto) are also not recommended in pregnancy.

If you're taking any of these medications, you should make sure you use contraception when having sex to avoid becoming pregnant.

If you're on anticoagulants and find out you're pregnant or plan to start trying for a baby, speak to your GP or anticoagulant clinic about stopping or changing your prescription. Injections of an anticoagulant called heparin can be given while you're pregnant if necessary.

Breastfeeding

You can usually take warfarin while you're breastfeeding, but you should discuss this with your GP or midwife first.

Heparin is also safe to take while you're breastfeeding.

Apixaban, dabigatran and rivaroxaban aren't recommended if you're breastfeeding because it's not clear if they're safe for the baby.

If you're on anticoagulants and are breastfeeding or planning to breastfeed, speak to your GP, anticoagulant clinic or midwife to find out if you need to change your prescription.

Avoiding injury

Taking anticoagulant medicines can make you more prone to bleeding if you are injured. Try to avoid minor injuries and cuts and grazes by:

• taking care when brushing your teeth and shaving – consider using a soft toothbrush and an electric razor
• using insect repellent to avoid insect bites or stings
• using protection when gardening, sewing or playing sports

Your GP or anticoagulant clinic may advise you to avoid contact sports because of the risk of excessive bleeding.

Other medications and remedies

If you're taking anticoagulants, you should speak to your GP, anticoagulant clinic or pharmacist before taking any other medication, remedy or supplement.

This includes prescription medicines, medicines bought over the counter without a prescription (such as aspirin), and any herbal remedies (such as St John's Wort).

Some treatments can stop anticoagulants working or can increase the effect they have, which can be dangerous.

Some of the medicines that can affect anticoagulants include certain:

• antibiotics 
• antidepressants
• corticosteroids (medications used to reduce inflammation)
• anticonvulsants (medications used to treat epilepsy)
• non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen – take paracetamol instead if you need pain relief 

For a full list of medicines that you should avoid, find your medicine on the anticoagulant medicines information page or check the leaflet that comes with it.

Food and drink

It's important to have a healthy, balanced diet that includes lots of fruit and vegetables if you're taking anticoagulants, but you should avoid making frequent changes to the amount of green vegetables you eat and cranberry juice you drink if you're taking warfarin.

Cranberry juice and some green vegetables, such as broccoli, kale and spinach, contain a lot of vitamin K, which can reduce the effect of your medication.

You can still include these in your diet while taking warfarin, as the clinic will adjust your dose accordingly, but it’s important to be consistent in the amount you consume. You should also seek advice before taking supplements containing vitamin K.

The effect of warfarin is also affected by alcohol. If you're taking warfarin, don't drink more than one or two alcoholic drinks a day and never binge drink. 

These food and drink restrictions don't usually apply if you're taking apixaban, dabigatran and rivaroxaban, but you should check with your GP, anticoagulant clinic or pharmacist if you're not sure.