Revised March 2022

Important information for patients taking Apixaban, Dabigatran, Edoxaban and Rivaroxaban and their relatives and carers

A direct oral anticoagulant or DOAC is an anticoagulant (blood thinning) medicine.  These medicines are normally used to:

• Treat venous blood clots (deep vein thrombosis or pulmonary embolism).
• Prevent stroke in patients with atrial fibrillation.
• Prevent blood clots after hip and knee surgery.

Dabigatran was the first DOAC launched in the UK in 2011.  There are currently four DOACs available in the UK.    These are:

• Apixaban
• Dabigatran
• Edoxaban
• Rivaroxaban

When they were first made available to patients in the UK the DOACs were called novel oral anticoagulants or NOACs (you may still hear them being called this).  They are often now prescribed as an alternative to Warfarin, the traditional anticoagulant of choice.

This page provides you with important information on how to take these medicines safely.  You should also be provided with an anticoagulant alert card, which you should carry with you at all times when you are taking one of these medicines.  In the case of an emergency or if you are meeting a healthcare professional (e.g. dentist, doctor, pharmacist, nurse etc.) you should show them this card before you have any treatment. 

DOACs are used to treat different people for different reasons.  Another person prescribed the same medication may be on a different dose from you.  You should always take your medication as your doctor has directed you.  If you are unsure then you should speak with a doctor, nurse, pharmacist, or contact the anticoagulation team.

Monitoring

You will need to have some bloods when you first start and at least annually to check your kidneys, liver and blood count.  Occasionally people may need more frequent monitoring, for example those with kidney disease.

Repeat prescriptions

Repeat prescriptions should be ordered from your GP. It is very important that you do not run out of your medication.  You should aim to ensure that you always have at least a week of medication at home.

Duration

How long you take your DOAC for depends on the reason you were prescribed it.  Your doctor should discuss this with you at the start of treatment.  If you are unsure then please ask.  Some people may need a few months of treatment, while for others treatment is for life.

Interactions with other medication

Some medicines can interact with the DOACs.  It is important that whenever you are being started on a new medication you remind the prescriber you are on a DOAC.

This includes when changes are made to your current medication. If you buy medication from a pharmacy then always check with the pharmacist first, this includes herbal or alternative medicines.  You should not take aspirin or anti-inflammatory pain medication  (e.g. ibuprofen) unless it has been prescribed by a doctor.  Paracetamol is safe to take.

 

Interactions with food

Unlike Warfarin, none of the DOACs have any specific interactions  with food.  You should aim to eat a balanced and healthy diet.

NB:                    Rivaroxaban should be taken with a large meal.

 

Side-effects

The most serious side effect associated with any anticoagulant is bleeding.  It is important that if you experience any of the following then you seek medical attention:

• Prolonged nosebleeds (For longer than 1O minutes)
• Blood in vomit
• Blood in sputum (i.e. when you cough up blood)
• Passing blood in your urine or stools
• Passing black stools
• Severe or spontaneous bruising
• Unusual headaches
• For women: heavy or increased bleeding during your period or any other vaginal bleeding.
• Tiredness, dizziness, paleness or weakness
• Unexplained swelling
• If you cut yourself then you should apply firm pressure to the affected area for at least 5 minutes using a clean, dry dressing. You will also be at an increased risk of bruising.

Seek immediate medical attention if you:

• Are involved in major trauma (accident)
• Suffer a significant blow to the head.
• Are unable to stop bleeding
• You have taken too much of your DOAC

A full list of side effects can be found in the patient information  leaflet that comes with your medication.

Surgery or tooth extraction

If you are having an operation or invasive procedure (including dental procedures such as tooth extraction) it is important that you inform your dentist or clinician that you are on a DOAC.  You may need to stop your DOAC temporarily prior to the procedure.

Alcohol

You can drink alcohol while on a DOAC but it is recommended you do not exceed the national recommended daily limits, these are 2 units per day for men and women. One pint of beer is 2 units; a 25ml measure of spirit is 1 unit; a 125ml glass of wine is 1  unit.  You should not 'binge drink' while taking an anticoagulant as  this can be dangerous.

Pregnancy

It is not recommended to take DOACs during pregnancy as there is no information available on what the effects on the unborn child are.  Women of child bearing potential on a DOAC should ensure that they use an appropriate form of contraception and that they discuss future plans for pregnancy with a clinician before trying to conceive.  

For women who think they have become pregnant while taking a DOAC then confirmation via a pregnancy test should be done as soon as possible and an urgent appointment made with a  doctor.

Breastfeeding

Breastfeeding is not recommended while taking a DOAC.

Periods

Women may experience heavier periods while taking a DOAC   and may wish to discuss with a doctor.

Injury

It is important to minimise your risk of falls and injury. Do not take part in contact sports and minimise risk while undertaking manual work.

Information about the specific DOACs

Apixaban (Brand name = Eliquis®)

How should I take apixaban?

Apixaban should be swallowed whole with water. They can be taken either with or without food, but should be taken at roughly the same time each day.

What should I do if I miss a dose?

Take the dose as soon as you remember. On the following day you should take your usual dose as per normal.

Rivaroxaban (Brand name = Xarelto®)

How should I take rivaroxaban?

Rivaroxaban should be taken with water and should be taken with food (this should ideally be the largest meal of the day) at roughly the same time each day.  If you are unable to swallow the    tablets then they can be crushed and mixed with water immediately prior to taking.

What should I do if I miss a dose?

Rivaroxaban can be taken either once or twice a day depending  on the reason you are taking it.  If you are taking rivaroxaban, one 15mg tablet twice a day, you should take the dose as soon as you remember or you can take two 15mg tablets together at once.  You should make sure you do  not take more than two tablets in a single day.  On the following day then take your usual dose as normal.  If you are taking rivaroxaban once a day, you should take the tablet as soon as you remember.    On the following day then you should continue to take your normal dose.  Do not take more than  one dose in a single day to make up for a missed dose.

Dabigatran (Brand name = Pradaxa®)

How should I take dabigatran?

Dabigatran should be swallowed whole with water.   They can be taken with or without food, but should be taken at roughly the same time each day.   Do not open the capsules. The capsules should also be stored in their original container until ready to be taken.   They should not be stored in a dossette or pill box.   The capsules can be removed from the blister card by peeling off the backing foil - do not push through the blister foil.

What should I do if I miss a dose?

Dabigatran can be taken either once or twice a day depending on the reason you are taking it.   If you are taking dabigatran once a day, continue with your regular dose the next day.   Do not take more than one dose in a single day.   If you are taking dabigatran twice daily, if less than 6 hours until  the next dose then omit the missed dose.   Do not take a double dose to make up for missed doses.

Edoxaban (Brand name = Lixiana®)

How should I take edoxaban?

Edoxaban should be swallowed whole with water.   They can be taken with or without food, but should be taken at roughly the same time each day.  Edoxaban is taken once a day.  Edoxaban should be swallowed whole with water.   They can be taken with or without food, but should be taken at roughly the same time each day.

 

What should I do if I miss a dose?

You should take the dose as soon as you remember.   Do not take more than one tablet in a single day.   You should not double up to make up for a missed dose.   Take your next dose the following day as per normal.

Please call the maxillofacial surgery reception 01792 702222 and ask for the on call maxillofacial surgeon should you have any concerns.