Oral anticoagulant therapy with edoxaban, apixaban, rivaroxaban or dabigatran

Patient name …………………………………………

Patient hospital number …………………………………………

At discharge

• Patients on treatment prior to admission - no appointment required
• If oral anticoagulant therapy (edoxaban, apixaban, rivaroxaban or dabigatran) is NEWLY STARTED during the current admission for patients with ATRIAL FIBRILLATION (AF), a follow-up appointment with the CUH Anticoagulation Service post-discharge is NOT required.
• If oral anticoagulant therapy (edoxaban, apixaban, rivaroxaban or dabigatran) is NEWLY STARTED during the current admission for patients with ANY OTHER INDICATION (excluding AF), the patient will be invited to receive a telephone follow up appointment from the CUH Anticoagulation Service or be invited to attend an appointment at the Addenbrooke’s Anticoagulant Clinic at the date and time indicated below:-

Date of appointment:……………………………………………………………………………………………………………….

Time of appointment: ……………………………………………………………………………………………………………..

Telephone appointment or attendance at clinic?:………………………………………………………………….

(record details)

What are anticoagulants and why do I need to take them?

• An anticoagulant medicine increases the time that your blood takes to clot. These drugs are designed to prevent harmful blood clots from forming in blood vessels. You have been prescribed a type of oral anticoagulant known as a Direct Oral Anticoagulant (DOAC) such as edoxaban, apixaban, rivaroxaban or dabigatran.
• In addition to your anticoagulant it is important to take regularly any other medication prescribed by your doctor.

How long do I take the anticoagulant for?

This depends upon the exact medical reason/problem that you experienced. You will be given clear advice on how long to take the medication for.

How do I take my anticoagulant?

• You should take your medication according to the label on the box your medication is supplied in. Take your medication at about the same time every day.
• Your medication should be taken with food and should be ideally be swallowed whole with water. If you have trouble swallowing, consult your pharmacist.
• Do NOT stop taking your anticoagulant without talking to your doctor or pharmacist first unless you are experiencing serious side-effects (see below for a list of serious side –effects).

What do I do if I forget to take my anticoagulant?

Please read the section that applies to the anticoagulant that you are taking.

Edoxaban (Lixiana®)

• If you miss a dose, you should take the dose as soon as you remember on that day and then continue on the following day with the once daily tablet as usual. Do not take double the prescribed dose within the same day to make up for a forgotten dose.

Apixaban (Eliquis®)

• If you miss a dose, you should take the dose as soon as you remember on that day, and then continue with the twice daily tablet as usual. Do not take a double dose to make up for a forgotten dose.

Rivaroxaban (Xarelto®)

• If you take rivaroxaban 15mg twice a day and a dose is missed, you should take the dose as soon as you remember on that day. You may take two doses at the same time to make up for the missed dose, and then continue on the following day with the twice daily tablet as usual.
• If you take rivaroxaban once a day and a dose is missed, you should take the dose as soon as you remember on that day, and then continue on the following day with the once daily tablet as usual. Do not take double the prescribed dose within the same day to make up for a forgotten dose.

Dabigatran (Pradaxa®)

• If you miss a dose and it is more than six hours until your next dose, then you should take the dose as soon as you remember and take the next dose at the usual time. If it is less than six hours until your next dose, then you should omit the missed dose and take the next dose at the usual time. Do not take a double dose to make up for a forgotten dose.

Are there any side effects?

Common minor side-effects

• The most common side-effects are: indigestion, nausea, diarrhoea, mild rash or itching, minor bruising and signs of minor bleeding such as from your nose, mouth or gums (e.g. such as when brushing your teeth), in your urine and from the vagina (such as heavier bleeding during your period). These effects should settle on their own. If they persist for a prolonged period consult your GP.

Serious side effects

The most serious side effects of anticoagulant therapy are serious bleeding or bruising.

You should seek medical advice immediately by attending your Emergency Department or calling 999, if you experience any of the following symptoms:

• prolonged nose bleeds (more than ten minutes)
• vomiting or coughing up blood
• if you suffer a major injury or are unable to stop bleeding.
• if you have a fall or injure yourself while on this treatment especially if you hit your head
• pass significant amounts of blood in your urine (pink or brown in colour)
• passing significant amounts of blood in your stool (red or black in colour)
• severe or prolonged menstrual bleeding
• unexplained severe dizziness or weakness
• sudden severe headache
• exceptional tiredness or paleness
• unusual or severe bruising

If you cut yourself, apply firm pressure to the site for at least five minutes using a clean, dry dressing. If the bleeding does not stop within 10 minutes, go to your Emergency Department.

What can affect the control of my anticoagulation?

• Make sure your GP knows if you are taking any other medicines. Always inform your doctor if you are given a prescription for another drug.
• It is advisable to avoid a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs), unless specifically prescribed for you by a doctor who is aware you are taking an anticoagulant. NSAIDs are often used as pain killers and examples include aspirin, ibuprofen, diclofenac and naproxen.
• Paracetamol is a safe medicine to use as pain relief, if needed, alongside your anticoagulant.
• If you purchase any over the counter medication, vitamins, supplements or herbal remedies consult your pharmacist first to ensure these are safe to take with your anticoagulant.
• How well your anticoagulant works is not affected by alcohol, although if you drink alcohol, drink in moderation and within recommended guidelines.
• You should try to eat a healthy diet.

Who must I tell that I take anticoagulant therapy?

• Tell any doctor or health care professional prescribing you medicine that you currently take anticoagulant therapy. They will advise you which medicines are safe to take with your anticoagulant.
• Tell your pharmacist if you are planning to buy any additional over the counter medication, vitamins, supplements or herbal remedies
• Tell your dentist, or any health worker involved in your medical care.
• You should carry your anticoagulant alert card with you at all times.
• If you are due to have a surgical procedure or an invasive investigation, please tell the medical team carrying out the procedure or investigation that you are taking an anticoagulant. They will provide additional advice.

Other questions

• We recommend that women do not become pregnant while taking anticoagulant therapy. Please consult your GP regarding contraception if appropriate.
• If you think you may be pregnant contact your GP immediately for advice as these medicines should not be taken during pregnancy.
• You should not breast feed whilst taking these medicines.
• If you need further supplies of your medication in most cases this is from your GP unless you have been advised otherwise.

Follow-up

• Regular blood tests to monitor how well the anticoagulant is working are not routinely required with DOACs. You should meet with your GP annually to discuss continuing with this medication and how your health has been over the previous year, or at any time before then if you are unwell.

For further advice please contact:

Anticoagulation Service

Box 217, Addenbrooke’s Hospital

Hills Road Cambridge CB2 0QQ

Tel 01223 217127

Open: Monday to Friday 09:00 to 17:00 hours.