FAQs

This concern is common, and you should discuss your worry with your doctor. Try to concentrate on your freedom from taking pills that need blood testing. Doctors base the decision to stop anticoagulants on many factors such as what caused your clot, where it happened, and what your personal and family history of clots is. There is a lot of thought in their decision.

As directed by your doctor. Please do not cut a tablet as they are not scored; i.e., often the dose after 6 months is reduced 50% so if you are taking 5 mg of Eliquis twice a day and you are asked to reduce to 2.5 mg twice a day you will need a new prescription for 2.5 mg twice a day; same thing with 20 mg Xarelto daily being reduced to 10 mg a day.

If taking your medication as prescribed, and you did not miss any doses, the chance that you will re-clot is only 1-2 % at most. If you ever develop a blood clot when you are on anticoagulants, 3 most likely explanations are, 1. You have not been compliant with your medication, 2. You did not take the drug correctly i.e., you did not take with food, or 3. You are taking other medication which interfered with the anticoagulant. A good example of drug interference would be anti-seizure medication.

It is not unreasonable to check the complete blood count (CBC) and comprehensive metabolic panel (CMP) 1 – 2 times a year. If you are on coumadin you will need frequent blood testing about every 3 weeks. If you are on a DOAC like Apixaban or Rivaroxaban you will need blood testing less frequently (maybe every 6 months to make sure your kidney function is stable).

Yes, anticoagulants can have issues with other medications. Check with your doctor before getting prescribed anything like NSAID. Xarelto and Eliquis can react with certain seizure medicines, HIV medicines, anti-fungal medications, and TB medicines. There are very few other interactions. However, you should not take Xarelto with Paxlovid since it has an HIV medicine Ritonavir.  With Apixaban you should use half dose. warfarin (Coumadin) has many interactions, which is a good reason to use DOACs if you can for blood clots involving the legs and lungs.

There are some reversal agents for anticoagulants: Idarucizumab (reversal for dabigatran) & and Andexanet (reversal for apixaban (Eliquis), rivaroxaban (Xarelto), and (off-label) enoxaparin (Lovenox, and generics) in patients with active major bleeding. These are rarely used except for major life-threatening bleeds involving the brain or GI tract.

Usually, you would decide this based on if the blood clot was provoked or unprovoked and whether on-going risk factors are present such as obesity (body mass index >30) or being above the age of 55. Permanent risk factors or unprovoked blood clots are most likely to be treated long term because they have the highest rates of recurrence.

Talk to your healthcare team about which medication is right for you. Usually a direct anticoagulant (DOAC) such as Eliquis (apixaban) or Xarelto (rivaroxaban) is prescribed over warfarin (coumadin) as they are not affected by your diet nor most medications like warfarin. They also do not require periodic blood draw monitoring, but one exception is APAS. Eliquis is typically prescribed if there is a perceived higher bleeding risk i.e., menstruating female or if the patient has renal failure while Xarelto is preferable due to daily dosing instead of twice a day with Eliquis. Endoxaban and Dabigatran (Pradaxa) are other DOACs that do not require monitoring. Regardless of what anticoagulation medication is chosen, the treatment goals should include:

• Stop an existing clot from growing
• Preventing the formation of a new clot in other vein segments that could break off and travel to the lungs and become a PE
• Avoiding or minimizing any long-term complications

There are three main anticoagulants: rivaroxaban (Xarelto), apixaban (Eliquis), dabigatran (Pradaxa which is less common). Potential side effects include:

• An unfamiliar headache
  • While you will notice bleeding from your GI tract, your nose, and your skin; you may not realize that an unfamiliar headache can be a sign of bleeding in the brain so if you get an unfamiliar or more severe than usual headache you should contact your doctor
• Blood in your urine or stools
• In women, heavy bleeding during a period or excessive vaginal bleeding during the 6-week post-partum period
• Severe bruising
• Prolonged nosebleeds (lasting longer than 10 minutes)
• Coughing up blood
• If you have hemorrhoids, you might bleed a little more
• Learn more about Warfarin or Heparin.

These medications do not actually “thin” the blood, they do slow the body’s ability to form new clots, keep existing clots from getting bigger, and they prevent clots from travelling or embolizing.