Warfarin, apixaban (Eliquis), dabigatran (Pradaxa) and rivaroxaban (Xarelto) are a group of medicines that work by reducing the ability of blood to clot. They are also called ‘anticoagulants’. Apixaban (Eliquis), dabigatran (Pradaxa) and rivaroxaban (Xarelto) are also known as ‘NOACs’ (an abbreviation of ‘non-vitamin K antagonist oral anticoagulants’).

You are at risk of developing blood clots if you:

• have had hip or knee replacement surgery recently
  
• are already at increased risk of having a stroke or getting a blood clot
  
• have an existing blood clot in your lungs or legs.
  

You can be prescribed an anticoagulant to:

• reduce the chance of blood clots forming in the brain, which may possibly lead to a stroke
  
• treat or prevent blood clots in the lungs (pulmonary embolism, or ‘PE’)
  
• treat or prevent blood clots in deep veins, like those in the legs (deep vein thrombosis, or ‘DVT’). 
  

If you take warfarin, apixaban (Eliquis), dabigatran (Pradaxa) or rivaroxaban (Xarelto), it is important to use the medicine safely and correctly.

The benefits of these medicines need to be carefully balanced with possible side effects. Not enough anticoagulation can lead to a blood clot or stroke, but too much anticoagulation can lead to uncontrolled or serious bleeding.

If you are taking an anticoagulant, read the tips below to help reduce your risk of bleeding.

If you are specifically taking warfarin, there are some extra tips to follow. They can be found here.

• Take your medicine as prescribed.
• Understand important information about your medicine such as how and when to take it, how long to take it for, and what to do if you forget to take it or take too much. See Taking a NOAC for more detailed information.
  
• Make sure your prescriber and pharmacist know all the other medicines you take regularly. A medicines list can be a useful way to keep all the information about your medicines together.
• Check with your doctor, nurse or pharmacist before you take any new medicines, in case there is a risk of interactions. This includes non-prescription and complementary medicines such as herbs and vitamins.
  
• Tell all your healthcare providers, including your dentist, that you are taking an anticoagulant.
• Keep an eye out for signs of bleeding and report them to you doctor or nurse. Signs include bleeding gums, red or black bowel motions and if you are bruising easily.
  
• Keep all your healthcare providers informed of your medical history. Information that is very important includes being over 75 years old, having reduced kidney function, current or previous history of cancer, previous stomach or bowel ulcer, or a recent bleed, biopsy or serious injury.

Before you start taking your anticoagulant medicine for the first time, your doctor will do a complete blood test, check how fast your blood can clot under normal conditions, and check the health of your liver and kidneys (often described as liver function and kidney function).

While you are taking apixaban (Eliquis), dabigatran (Pradaxa) or rivaroxaban (Xarelto), it is important that you look out for signs of bleeding and report them to your doctor or nurse. Signs include bleeding gums, red or black bowel motions and if you are bruising easily.

Your doctor will need to check your kidney function at least once every year, and re-check it if your health condition or medicine changes.

If you take warfarin your doctor or nurse will organise for routine blood tests to monitor the anticoagulant effects of that medicine. 

Find out more about warfarin and how to take it

Whatever the medicine is, you should take it exactly as prescribed by your doctor or nurse. For medicines like anticoagulants it is also important to take it at the same times every day.

How and when to take it

Unless advised differently by your doctor, nurse or pharmacist, swallow the recommended number of tablets whole with a full glass of water.

The dose, and how often you need to take it, can vary depending on a number of things, including:

• which medicine you have been prescribed
  
• what health condition you are taking it for
  
• your age and body weight
  
• your kidney function
  
• your bleeding risk.
  

Do not change your dose unless you have been instructed to do so by your prescriber. If you are changing your dose - make sure you are clear about the new amount and when to start taking it.

If you’re not sure of what to take and when, don’t be afraid to double check with a doctor, nurse or pharmacist. They can let you know if you have to take the medicine with food (so it will work properly), or if you should keep the medicine in its packaging until you are ready to take it.

How long to take it for

Continue taking your medicine for as long as your doctor or nurse tells you. Do not stop taking it or change how you take it without checking with your prescriber first.

Stopping can put you at increased risk of developing a blood clot, which may lead to a serious condition, such as a stroke.

What to do if you forget to take it

Keep a note of any missed doses and seek advice from a doctor, nurse or pharmacist – do not take a double dose to make up for the forgotten tablet.

What to do if you take too much

Get immediate emergency medical help if you have taken too much anticoagulant medicine – even if there is no discomfort or signs of poisoning. Taking too much of this type of medicine may lead to serious bleeding that may not stop without emergency treatment.

This information is for people who are taking apixaban (Eliquis), dabigatran (Pradaxa) or rivaroxaban (Xarelto). If you take warfarin you can find more about side effects here.

Bleeding is probably the most serious side effect, but other side effects may include headache, nausea, diarrhoea or constipation, fever and coughing.

Symptoms such as shortness of breath, rash, itching and swelling of the face, lips or tongue may mean an allergic reaction and should be considered a medical emergency. If you are experiencing any of these symptoms - dial 000 or go immediately to the nearest hospital Emergency Department.

Signs and symptoms of bleeding

Signs and symptoms of bleeding can include:

• bruising
  
• bleeding gums
  
• red or dark brown urine
  
• red or black bowel motions
  
• nosebleeds
  
• coughing up blood or blood in your spit
  
• trouble breathing or swallowing
  
• heavier than usual menstrual period
  
• bleeding from cuts, wounds and scrapes that takes longer to stop
  
• dark or blood-stained vomit
  
• severe headache or dizziness
  
• unexplained pain, swelling or discomfort.
  

Some types of bleeding are more serious than others. If bleeding concerns you, is heavier than usual or takes an unusually long time to stop, you should speak to your health professional right away.

If you have questions about your medicine or need general information about side effects, you can call the NPS Medicines Line on 1300 633 424 (Monday to Friday, 9 am to 5 pm).

This is not a complete list of side effects. Occasionally people may experience other side effects. If you feel unwell while taking apixaban, dabigatran or rivaroxaban,  speak with your doctor, nurse or pharmacist, even if you don’t think it’s related to your medicine.

Fact sheets:

• Information for patients on anticoagulant medicines (translated versions available), developed by the Clinical Excellence Commission.
  
• St John bleeding factsheet
  
• Information about blood clots from the American Society of Hematology.

Phone services:

• Medicines Line 1300 MEDICINES (1300 633 424) if you have questions about your medicines
  
• Healthdirect (1800 022 222) for free immediate health advice from experienced nurses
  
• Stroke Foundation’s StrokeLine (1800 787 653) for support and services for someone who has survived a stroke, their family and carers
• Heart Foundation helpline (13 11 12) for free information, guidance and support to help people improve their heart health