1. Pay attention to new or worsening bleeding
"The main side effect of anticoagulants is bleeding," says Dr. Christopher B. Granger, a cardiologist from Duke University Medical Center in North Carolina. This isn’t surprising, since their purpose is to suppress the blood’s ability to clot—but it makes it harder for wounds to heal. So, if you get cut or scratched, more blood will flow from the wound, and nosebleeds may also worsen.
Dr. Mary Cushman from the University of Vermont Medical Center in Burlington says that even in such cases, you shouldn’t stop taking anticoagulants. What you can do is check with your doctor or pharmacist to see if there are special bandages or products that can help. However, if you notice blood in your urine, cough, vomit, or black stool, it could indicate internal organ bleeding, and you should immediately see a doctor and get checked.
2. Consult your doctor about the frequency of blood tests
"Drugs like warfarin (Coumadin) require you to frequently do blood tests to ensure you’re taking the right dose for you and that your blood isn’t getting too thin," says Dr. Cushman. "At first, it might be 2-3 times a week, and once things stabilize, it becomes once every 4 weeks." Dr. Granger explains that there are newer drugs that don’t require as many blood tests, such as Xarelto (rivaroxaban) and Eliquis (apixaban), which cause fewer bleeds, especially in the brain—the most dangerous type of bleeding that can result from taking anticoagulants.
3. Tell your doctor about any other medications you’re taking
If you’re taking other medications or even dietary supplements, Dr. Granger warns that it could be dangerous when combined with anticoagulants. Even over-the-counter drugs like ibuprofen can increase your risk of bleeding, especially if you’re taking older types of anticoagulants. Here’s a full list of medications and supplements that could be dangerous when combined with older anticoagulants (heparin, Clexane, and Coumadin):
- Aspirin
- Pain relievers like paracetamol (Acamol, Dexamol, etc.)
- Heartburn medications, like Tums
- Laxatives, like Laxadin
- Medications for treating COVID-19, like Paxlovid
- Various types of antibiotics
- Antifungal medications (like fluconazole and Diflucan)
- Nonsteroidal anti-inflammatory drugs, like ibuprofen (Advil, Ibuprofen, Adex, Nurofen) and naproxen (Naxyn)
- Medications for treating heart arrhythmias, like amiodarone (Procor, Amiocor, Amiodacore)
- Anti-seizure medications, like phenytoin (Epanutin), phenobarbital (Luminal), and carbamazepine (Tegretol)
- Dietary supplements containing dong quai, garlic, ginkgo biloba, ginseng, green tea, St. John’s wort, and vitamin E.
Additionally, even if you’ve told your doctor that you’re taking these medications and supplements and they approved your use of anticoagulants with them, you should consult them before stopping those medications or supplements. Any change is significant.
4. Don’t sit for too long
Whether at home, in the car, or even on a plane, sitting for long hours can increase your risk of developing blood clots. While anticoagulants help prevent this issue, you should still get up and move your body after every two hours of sitting. What if you can’t get up from your seat? If possible, push your feet up and down in point-and-flex movements with your feet to activate your calves—do anything you can to keep the blood flowing.
5. Be consistent with your vitamin K intake
Drugs like warfarin reduce the clotting effects of vitamin K, which is found in many green vegetables like kale, broccoli, Brussels sprouts, and more. However, if you eat too much of them and get a lot of vitamin K, it could reduce the drug’s effectiveness. So make sure you eat green vegetables in moderation and in the same amount every day. You don’t need to avoid them, just be consistent with how much you consume.
6. Drink plenty of water and avoid excessive alcohol
Dehydration causes blood vessels to constrict and blood to thicken, increasing your risk of facing dangers related to blood clots. That’s why it’s important to drink enough water every day, especially in the summer. Plus, a full bladder will make you get up to use the bathroom more often, which will help you avoid prolonged sitting, as we’ve already recommended. At the same time, it’s advised not to overdo it with alcohol, as it can affect how drugs like warfarin are absorbed in the body.
7. Seek immediate medical attention if you fall or get hit in the head
Even if you don’t see external bleeding, that doesn’t mean there’s no internal bleeding, and in the case of a head injury, it can be very dangerous. This is another reason to avoid excessive alcohol consumption, even if you’re taking newer anticoagulants, as overdrinking increases your risk of falling and getting injured.
8. Don’t double up on a missed dose
You need to take your anticoagulants every day as per your doctor’s instructions. If you forget one dose, don’t double the next dose to make up for it.
- If you’re taking older-generation anticoagulants – you can take the missed dose up to 8 hours from the time you were supposed to take it, but if more than 8 hours have passed, it’s recommended to wait until the next day and the next dose.
- If you’re taking newer-generation anticoagulants – as long as less than half the time between when you were supposed to take the dose and the next one has passed, you can take it. If more than half the time has passed, wait for the next dose.
