The Basics
Written by the doctors and editors at UpToDate � �
What are the latest medicines to prevent and treat blood clots? " � These medicines include dabigatran (brand name: Pradaxa), rivaroxaban (brand name: Xarelto), and apixaban (brand name: Eliquis). They are prescription medicines that make your blood less likely to clot. They are also known as "blood thinners " � and "anti-clotting medicines. " � � �
How are these medicines different from warfarin? " � Warfarin (brand name: Coumadin) has been used for many years to prevent and treat blood clots. The latest medicines (dabigatran, rivaroxaban, and apixaban) work as well as warfarin but have some differences: � �
- People taking the latest medicines do not need regular blood tests or changes in the dose. People taking warfarin do need blood tests about once a week to once a month, and they sometimes need to change their dose.
- People taking the latest medicines have no special rules about how to eat. People taking warfarin have to watch the amount of leafy greens and other vegetables they eat and try to eat about the same amount every day. These foods contain Vitamin K, which affects the warfarin dose.
- Dabigatran, rivaroxaban, and apixaban have no antidote. If a person starts bleeding while on these medicines, doctors have no way to undo their effects except to wait for them to wear off. Warfarin has an antidote.
- Dabigatran and apixaban are taken once or twice a day depending on what they are prescribed for. Rivaroxaban is taken once a day. Warfarin is taken once a day.
All of the anti-clotting medicines protect against blood clots, and all of them can cause bleeding. Some of their differences are a matter of convenience, and some can be more serious. Ask your doctor which of the medicines is best for you. � �
Why might my doctor prescribe an anti-clotting medicine? " � The main reasons doctors prescribe anti-clotting medicines are to prevent blood clots or to treat blood clots that have already formed. Nothing can completely prevent all blood clots, but these medicines lower the risk of clots. � �
These medicines do not dissolve clots, but they keep them from growing bigger and moving to another part of the body. � �
Doctors prescribe anti-clotting medicines to people who have a heart rhythm problem called "atrial fibrillation. " � In people with this condition, the medicine helps lower the risk of stroke from a blood clot. � �
Doctors prescribe anti-clotting medicines to people who have had a hip or knee replaced. These medicines help prevent a blood clot in the legs (called a "deep vein thrombosis " � or "DVT " �) or the lungs (called a "pulmonary embolism " � or "PE " �). � �
Doctors can also prescribe rivaroxaban to treat a blood clot that has already formed in the legs or lungs. � �
If you need an anti-clotting medicine, your doctor might order blood tests to check how well your kidneys work. If you have or develop kidney trouble, the latest anti-clotting medicines might not be right for you. � �
If you take 1 of the newer medicines to prevent blood clots, there are certain things you should do. These are described below. � �
- Know the strength (mg) of your clot-preventing medicine, what the pills look like, and why your doctor prescribed it for you " � Always refill your prescription before you run out of pills.
- Take your medicine as directed " � It is very important to take these medicines exactly as your doctor tells you to. Take them at the same time each day and do not skip any doses. Do not take 2 doses at once, change the dose, or stop taking this drug without talking to your doctor. Do not take medicines to prevent blood clots with grapefruit or grapefruit juice, because grapefruit can change the effects of these medicines.
- Store dabigatran pills in the bottle they came in " � Do not put this medicine in any other container, such as a pill box or pill organizer. After you open the bottle, use the pills within 4 months.
- Do not break, chew, or open the dabigatran capsules " � This can change the strength of the medicine. Take dabigatran with a full glass of water after a meal and do not lie down for at least a half hour after taking it. This will lessen the chance of heartburn or an upset stomach.
- Do not take pain relievers like ibuprofen, naproxen, or aspirin " � If you need a pain reliever, ask your doctor which 1 is safe. Acetaminophen (brand name Tylenol) is usually OK.
- Ask your doctor before taking any new medicines - This includes prescription medicines, over-the-counter medicines, and herbal medicines. Certain medicines (especially antibiotics and St. Johns wort) can change the effects of the newer anti-clotting medicines.
- Wear a medical alert tag - Always wear a bracelet, necklace, or another kind of alert tag that warns people that you take an anti-clotting medicine and why. That way, if you are in an accident and are unable to explain your condition, responders will know how to care for you. Your alert tag should also have the name and phone number of an emergency contact.
What are the side effects of the newer medicines to prevent blood clots? " � The most common side effect is bleeding from any part of your body. The bleeding can be minor or sometimes serious. This even includes inside your body, where you cannot see it. � �
Call your doctor right away if you took more medicine than you were supposed to or if you have any of these possible signs of bleeding: � �
- Feel sick to your stomach or throwing up blood or something that looks like coffee grounds
- Headaches, dizziness, and weakness
- Nosebleeds
- Dark red or brown urine
- Blood in your bowel movements or dark-colored bowel movements
- Pain and swelling after an injury
You should also call you doctor if you: � �
- Bleed from your gums after brushing your teeth
- Swell or have pain where you got an injection (shot)
- Have heavy menstrual periods or bleeding between periods
- Have diarrhea, vomit, or are unable to eat for more than 24 hours
- Have a fever (temperature higher than 100.4 � � � or 38 � � �)
- Cannot take your clot preventing medicine for any reason
Is there anything I can do to lower the risk of bleeding? " � Yes. You should: � �
- Use a soft bristle toothbrush
- Floss with waxed floss (not unwaxed floss)
- Shave with an electric razor rather than a razor blade
- Take care when using sharp objects, such as knives and scissors
- Avoid doing things might make you likely to fall, such as walking on slippery surfaces or climbing on a high stool
- Let a doctor or nurse know you are taking these medicines before they give you a shot or do surgery
- If you see a new doctor, let him or her know you are taking these medicines
For more detailed information about your medicines, ask your doctor or nurse for information from Lexicomp available through UpToDate. The Lexicomp hand-outs explain how to use and store your medicines. They also list possible side effects and warn you if your medicines should not be taken with certain other medicines or foods. � �
All topics are updated as new evidence becomes available and our peer review process is complete. � �
This topic retrieved from UpToDate on: Oct 06, 2014. � �
Topic 86638 Version 3.0 � �
Release: 22.8 - C22.187 � �
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