your limit has been reached. plz Donate us to allow your ip full access, Email: sshnevis@outlook.com

Patient education: Taking medicines for blood clots (The Basics)

Please read the Disclaimer at the end of this page.

What is a blood clot? — Normally, your body is protected from bleeding because your blood vessels seal over after an injury. The seal is made by proteins and cells in the blood. Sometimes, these proteins and cells form a "clot" inside a blood vessel. Blood clots can be dangerous because they can stop blood from flowing. They can also break off and travel in the bloodstream to another part of the body, like the brain or the lungs.

Medicines used for blood clots are also known as "anticoagulants" or "blood thinners." They do not actually thin the blood. They just make the blood less likely to form clots.

You might be prescribed 1 of these medicines for either of the following reasons:

●You had a blood clot – Medicine helps stop the clot from getting worse.

●Your risk of a blood clot is high – Medicine helps prevent new clots from forming.

There are several medicines that can be used, including many that can be taken as a pill. These include:

●Apixaban (brand name: Eliquis)

●Dabigatran (brand name: Pradaxa)

●Edoxaban (brand names: Savaysa, Lixiana)

●Rivaroxaban (brand name: Xarelto)

●Warfarin (brand name: Jantoven)

Each medicine is different. They have different doses. Some are taken once a day and some twice a day. Some are more expensive than others. And some are more affected by what you eat. The table answers some common questions about the differences (table 1).

How should I take my medicine? — It depends on which medicine you take. Your pills will come with specific instructions, and your doctor or pharmacist will talk to you about what you need to do. If you take warfarin, you might also work with an "anticoagulation clinic." People taking warfarin need to have their blood checked, and sometimes their dose needs to be adjusted.

Below are some general tips:

●Know the strength of your medicine and what the pills look like – The strength of the medicine is given in milligrams ("mg"). If the color, shape, or strength of your pills looks different from those you have taken before, check with your doctor or pharmacist.

●Take your medicine exactly as told – Try to take your medicine at the same time each day (or at the same set of times, if you take it twice a day). In addition:

•Dabigatran should be taken with a full glass of water after a meal.

•In some cases, rivaroxaban should be taken with food.

Do not change your dose or stop your medicine without talking to your doctor. Always refill your prescription before you run out of pills.

If you forget or miss a dose, or accidentally take more than you were supposed to, call your doctor or anticoagulation clinic to find out what to do. The instructions that come with your medicine might tell you what to do if you miss a dose.

●Use a pill box to stay organized – Some people find it helpful to use a weekly pill box (picture 1). This can help you keep track of your medicine and make sure you take all your doses.

One exception is if you take dabigatran. This medicine should not be stored in a pill box. You should always keep dabigatran pills in the original bottle or package they came in.

●Get your blood tested – If you take warfarin, you will need to have your blood tested to check how your blood is clotting. This test is called a "PT and INR". This is important in order to make sure you get the correct dose of warfarin for you. Once you are on a regular dose, you can have a PT and INR test less often, unless your diet changes, you get sick, or you start a new medicine.

If you take apixaban, dabigatran, edoxaban, or rivaroxaban, you will not need regular blood tests to check how the medicine is working. But your doctor might do a blood test once in a while to check your kidneys or liver.

●Check before taking any new medicines – Ask your doctor, pharmacist, or anticoagulation clinic before taking any new medicines. This includes prescription or over-the-counter medicines, herbs, and vitamins. Certain medicines and remedies can change the way some of these medicines work. In particular, a lot of medicines can affect the way warfarin works, especially vitamin K. So it's very important to check before taking any new medicines or stopping any medicines you already take.

Do not use medicines that contain an "NSAID" for treating pain or fever unless you talk to your doctor first. NSAIDs are a group of medicines that includes aspirin, ibuprofen (sample brand names: Advil, Motrin), and naproxen (sample brand names: Aleve, Naprosyn). They can increase your risk of bleeding, especially if combined with a medicine for blood clots.

Also, make sure every doctor knows that you take a medicine for blood clots and which one you take. That way, the doctor can check whether the new medicine might change the way it works.

●Follow instructions about diet – If you are taking apixaban, dabigatran, edoxaban, or rivaroxaban, there are not very many rules about diet.

If you take warfarin, you will need to make sure to eat about the same amount of vitamin K from foods every day. Do not take vitamin K supplements unless your doctor tells you to. Vitamin K affects how warfarin works. Some leafy green and other vegetables are high in vitamin K. The table lists the amount of vitamin K in foods (table 2).

●If you get sick, tell your doctor – If you have vomiting, diarrhea, a fever, or an infection, or if you cannot eat, tell your doctor. If you take warfarin, you might need a blood test and/or a change in dose. If you cannot keep down the pills, you might need a different type of medicine for blood clots that comes as a shot.

●Wear a medical alert tag – Always wear a bracelet, necklace, or alert tag (or carry a wallet card) that warns people that you take a medicine for blood clots and the name of the medicine. That way, if you are in an accident and are unable to explain your condition, people will know how to care for you. Your alert tag should also have the name and phone number of an emergency contact person.

●If you might get pregnant, talk to your doctor – These medicines are not recommended during pregnancy. If you could get pregnant, talk to your doctor about birth control options. It's also important to tell your doctor right away if you get pregnant while taking one of these medicines.

What are the risks of these medicines? — The major risk is bleeding. It's important to protect yourself from getting injured.

Bleeding can happen after an injury, but sometimes bleeding happens without an injury. If you have any signs of bleeding, you should get treatment as soon as possible.

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

●Have a serious accident, fall, hit your head, or get another serious injury that could cause bleeding.

●Throw up blood or something that looks like coffee grounds.

●Have a severe headache

●Have trouble talking, weakness, or loss of function of one of your arms or legs

Call your doctor right away if you:

●Took more medicine than you were supposed to.

●Have any of these signs of abnormal bleeding:

•Feeling sick to your stomach

•Blood in your bowel movements or dark-colored bowel movements

•Headaches or dizziness

•Nosebleeds or any bleeding that does not stop

•Dark red or brown urine

You should also tell your doctor if you:

●Bleed from your gums after brushing your teeth

●Have heavy menstrual periods or bleeding between periods

●Have more bruising than usual after a minor injury

●Have diarrhea, vomit, or are unable to eat for more than 24 hours

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

●Cannot take your medicine for any reason

How can I lower my risk of bleeding? — You can:

●Avoid doing things that could lead to a fall, such as walking on slippery surfaces or climbing on a high stool.

●Avoid sports that might cause injury.

●Use care when handling sharp tools, or avoid them when possible. Examples of tools that could cause serious bleeding if they cut you are sharp knives, saws, and straight edge razors.

●Always use a seatbelt in the car, and wear a helmet if you ride a bicycle or motorcycle.

●Avoid drinking a lot of alcohol, which can increase your risk of bleeding. If you drink, limit yourself to no more than 1 to 2 servings per day. 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 need surgery, tell the surgeon you are taking a medicine to for blood clots, and tell them which one.

●If you see a new doctor, dentist, or nurse, let them know you are taking a medicine for blood clots, and tell them which one.

For more detailed information about your medicines, ask your doctor or nurse for the patient hand-out from Lexicomp available through 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.