What should I consider when taking anticoagulants

If you're prescribed anticoagulants, always follow the instructions of your GP or other healthcare professional.

Some of the main issues you'll need to consider while taking your medication are outlined below.

Having surgery

If you're taking anticoagulants and you need to have surgery or any kind of invasive procedure, make sure that the healthcare professionals treating you are aware of your medication. This includes procedures used to diagnose other conditions, such asan Endoscopy or cystoscopy .

As anticoagulants reduce the ability of your blood to clot, there's a risk you could experience heavy bleedingif any kind of cut (incision) is made during a procedure. You may therefore be advised to stop taking your medication before surgery.

If you're having a dental procedure, such as having a tooth removed, tell your dentist that you take anticoagulants. You may not need to stop taking your medication, but you might need to have a blood test before the procedure to make sure your blood clots at the right speed.

Only stop taking your medication on the advice of your GP or another healthcare professional.

Pregnancy

Warfarin isnt normally given to pregnant women because it can affect the unborn baby. This can cause birth defects or excessive bleeding from the placenta or foetus.

It may sometimes be used in the second trimester, but should never be taken during the first trimester and should ideally be avoided in the third trimester as well.

The newer anticoagulant medications apixaban (Eliquis) , dabigatran (Pradaxa) and rivaroxaban (Xarelto) are also not recommended in pregnancy.

If you're taking any of these medications, you should make sure you use contraception when having sex to avoid becoming pregnant.

If you're on anticoagulants and find out you're pregnant or plan to start trying for a baby, speak to your GP or anticoagulant clinic about stopping or changing your prescription.Injections of an anticoagulant called heparin can be given while you're pregnantif necessary.

Breastfeeding

You can usually take warfarin while you're breastfeeding, butyou should discuss this withyour GP or midwife first.

Heparin is also safe to take while you're breastfeeding.

Apixaban, dabigatran and rivaroxabanaren't recommended if you're breastfeeding because it's not clear if they're safe for the baby.

If you're on anticoagulants andare breastfeeding or planning to breastfeed, speak to your GP, anticoagulant clinicor midwife to find out if you need to change your prescription.

Avoiding injury

Taking anticoagulant medicines can make you more prone to bleeding if you are injured. Try to avoid minor injuries and cuts and grazes by:

• taking care when brushing your teeth and shaving consider using a soft toothbrush and an electric razor
• using insect repellent to avoid insect bites or stings
• using protection when gardening, sewing or playingsports

YourGP or anticoagulant clinic may advise you toavoid contactsports because of the risk of excessive bleeding.

Other medications and remedies

If you're taking anticoagulants, you should speak to your GP, anticoagulant clinic or pharmacist before taking any other medication, remedy or supplement.

Thisincludes prescription medicines, medicines bought over the counterwithout a prescription (such as aspirin ), and any herbal remedies (such as St John's Wort).

Some treatments can stop anticoagulants working or can increase the effect they have, which can be dangerous.

Some of the medicines that can affect anticoagulants include certain:

• antibiotics
• antidepressants
• corticosteroids (medications used to reduce inflammation)
• anticonvulsants (medications used to treat epilepsy )
• non-steroidal anti-inflammatory drugs (NSAIDs) , such as ibuprofen take paracetamol instead ifyou need pain relief

For a full list of medicines that you should avoid,findyour medicineon the anticoagulant medicines information page orcheck the leaflet that comes with it.

Food and drink

It's important to have a healthy, balanced diet that includes lots of fruit and vegetables if you're taking anticoagulants, but you should avoid making frequent changes to the amount of green vegetables you eat and cranberry juice you drink if you're taking warfarin.

Cranberry juice and some green vegetables, such as broccoli, kale and spinach, contain a lot of vitamin K, which can reduce the effect of your medication.

You can still include these in your diet while taking warfarin, as the clinic will adjust your dose accordingly, but its important to be consistent in the amount you consume. You should also seek advice before taking supplements containing vitamin K.

The effect of warfarin is also affected by alcohol. If you're taking warfarin, don't drink more than one or two alcoholic drinks a day and never binge drink .

These food and drink restrictions don't usually apply if you're taking apixaban, dabigatran and rivaroxaban, but you should check withyour GP, anticoagulant clinicor pharmacist if you're not sure.