Anticoagulants - Anticoagulants - Which one?

Anticoagulants are used to reduce the body’s ability to form blood clots or to prevent existing clots getting bigger.

Certain illnesses, medical procedures or existing physical problems require people to take anticoagulants to either prevent clots or treat existing ones.

These include:

• An irregular heartbeat
• Surgical procedures
• Reduced mobility
• Recent stroke
• Being pregnant or recently given birth
• Deep Vein Thrombosis
• Pulmonary Embolism
• Heart Attack

Although all anticoagulants work on the clotting process within the body, different types of anticoagulants work in different ways and have different requirements in their management.

Anticoagulants are split into different groups; those which can be taken by mouth as tablets and those which require to be injected into the skin.

The decision on which anticoagulant to use is dependent on why it is required and any medication already being taken. For example a patient who is pregnant will require injections instead of tablets. Any decision on which type to take should be made after a discussion between the patient/carer and a medical professional.
 
You may also need to consider lifestyle activities such as sports and travel when deciding on an anticoagulant. For people who travel away for periods of time they may find it difficult to keep anticoagulant appointments to have regular blood tests for Warfarin, and people who partake in contact sports should consider this when discussing which anticoagulant to take.

Inform your travel insurance company you are taking an anticoagulant before travelling.

Common types of anticoagulants which are injected are:

• Enoxaparin (also known as Clexane)
• Dalteparin (also known as Fragmin)
• Fondaparinux (also known as Arixtra)

All these are taken as an injection into the tummy once or twice a day. They can be injected by yourself, family or carer after being shown by trained staff.

A common side effect of these injections is bruising around the site of the injection. A “sharps bin” will be provided to put used syringes in to. When the sharps bin is full it needs to be returned to the department who provide your injections if your chemist does not accept them. Disposal of sharps bins varies from area to area.

Common types of anticoagulants taken as tablets once or twice a day are:

•    Warfarin
•    Acenocoumarol (also known as Sinthorome)
•    Apixaban (also known as Eliquis)
•    Rivaroxaban (also known as Xarelto)
•    Edoxaban (also known as Lixiana)
•    Dabigatran (also known as Pradaxa)

Warfarin/Acenocoumarol

The dose to be taken can vary on a daily basis. The dose will be worked out by your health care professional and is based on the result of blood tests which are undertaken on a regular basis.
Warfarin can be affected by certain foods, alcohol and medication. The tablets is best taken whole but can be provided in a liquid form.

Apixaban

Apixaban is taken twice a day, the dose is usually fixed and determined by the reason it is being taken. It can be taken with or without food and can be crushed for patients who are unable to swallow whole tablets. It does not require frequent blood testing and can be put into a dosette box or blister-pack.

Rivaroxaban

Rivaroxaban is taken once or twice a day and the dose is fixed but determined by the reason it is being taken. Rivaroxaban is required to be taken with food but does not require frequent blood testing and can be crushed for patients who are unable to swallow whole tablets. Rivaroxaban can also be put into a dosette box or blister-pack.

Edoxaban

Edoxaban is taken once a day and the dose to be taken is dependent on body weight. It can be taken with or without food and can be crushed. This can also be put into a dosette box or blister-pack.

Dabigatran

Dabigatran is taken once or twice a day and the dose generally fixed and determined by the reason it is being taken. The capsule should be swallowed whole but can be taken with or without food. Dabigatran cannot be removed from its original package until it is taken and is therefore not suitable for a conventional dosette box or blister-pack.

Common side effects of all anticoagulants

• Bruising
• Prolonged bleeding of cuts or injuries

Side Effects which require immediate medical review by your nearest hospital

• Excessive bleeding
• Vomiting or coughing or passing blood
• Vomiting or coughing or passing dark matter (stools/Urine)
• Head, eye or joint injury
• Excessive bruising
• Allergic reaction
• Sudden severe headache
• Any other concerns or changes to health

You can help provide more information on the safety of these medications by reporting any side effects to www.mhra.ov.uk/ yellowcard.

Duration

Depending on the reason you take your anticoagulant will partly depend on how long you need to take it. Other factors which will also be considered will be any additional health problems and any medication you may also need to take. Anticoagulants can be taken for a few weeks following surgery to life long for people who have ongoing risks of developing blood clots.

To prevent unwanted blood clots forming always try to take your prescribed anticoagulant as directed and at the same time each day.

• Anti-platelet medication such as Aspirin or Clopidogrel can increase your risk of bleeding.
• Always inform your dentist you are taking an anticoagulant as there is an increased risk of bleeding and infection
• Always ensure your health care provider is aware you are taking an anticoagulant before starting any new medication (including herbal remedies).
• If you are taking an anticoagulant, you will be provided with a Patient Alert Card either in your box of tablets or (if prescribed warfarin or acencoumarol) from your anticoagulant clinic. This should be kept with you at all times and shown to any healthcare professional that treats you

Monitoring

If you are taking Warfarin you will be monitored by the anticoagulant team.

Other anticoagulants will be monitored by your GP or a designated health professional. If there are any changes to your health then you should discuss your anticoagulant with the health professional monitoring your anticoagulant. For example people who are trying or become pregnant may need to change their anticoagulant for a different type for a period of time.

Any complications from you anticoagulant which do not require immediate review can also be discussed with your health professional.

Patient Notes to complete with Health Professional Starting or Reviewing Anticoagulant

Diagnosis.
(If diagnosis is DVT or PE record the cause if known and if provoked or unprovoked)

Medication:
Name
Dose
Length of Treatment
Follow Up Details
 
Other Information

National Sites

Anticoagulant medicines - NHS https://www.nhs.uk/conditions/anticoagulants/