Anticoagulation ("Blood Thinners")
What Blood Thinners Do
- Prevent existing clots from getting larger.
- Help prevent new clots from forming.
- Allow the body to slowly break down the clot.
Common Medications
Apixaban (Eliquis®)
- What Is Apixaban?
- Apixaban is a blood thinner used to prevent and treat blood clots.
- It belongs to a group of medicines called direct oral anticoagulants (DOACs).
- It is commonly used to treat DVT (deep vein thrombosis) and PE (pulmonary embolism).
- It helps prevent existing clots from getting larger and reduces the risk of new clots forming.
How Is It Taken?
- Apixaban is taken by mouth as a tablet.
- It is usually taken twice each day.
- It can be taken with or without food.
- Try to take it at the same times each day.
- Do not stop taking apixaban unless instructed by your healthcare provider.
When Is Apixaban Commonly Used?
- To treat a newly diagnosed DVT or PE.
- To prevent another DVT or PE after initial treatment.
- For many patients after hospital discharge.
- As a long-term treatment option for patients at continued risk for blood clots.
- As a convenient alternative to warfarin because routine blood testing is usually not required.
Benefits of Apixaban
- Starts working quickly.
- Does not require routine INR blood tests.
- Has fewer food interactions than warfarin.
- Fixed dosing for most patients.
- Proven to be safe and effective for treating and preventing blood clots.
- Lower risk of major bleeding compared with warfarin in many patients.
Important Safety Information
- Take exactly as prescribed.
- Do not skip doses.
- Missing doses can increase your risk of another blood clot.
- Do not stop the medication without talking to your healthcare provider.
- Tell your healthcare provider if you develop:
- Unusual bleeding
- Large or unexplained bruises
- Black or bloody stools
- Blood in urine
- Severe headache
- Dizziness or weakness
- Coughing up blood
Medication and Supplement Interactions
- Tell your healthcare provider about all medicines, vitamins, and supplements you take.
- Some medications can increase bleeding risk.
- Common examples include:
- Aspirin
- Ibuprofen (Advil®, Motrin®)
- Naproxen (Aleve®)
- Certain antibiotics and antifungal medications
- Some herbal supplements such as St. John's Wort
- Do not start new medications without discussing them with your healthcare provider.
Pregnancy and Breastfeeding
- Apixaban is generally not recommended during pregnancy because there is limited safety information.
- Patients who become pregnant while taking apixaban should contact their healthcare provider immediately.
- Enoxaparin (Lovenox®) is usually preferred during pregnancy.
- Discuss breastfeeding and anticoagulation options with your healthcare provider.
Before Procedures or Surgery
- Tell all healthcare providers and dentists that you take apixaban.
- The medication may need to be stopped before surgery, dental work, or certain medical procedures.
- Never stop apixaban without instructions from your healthcare provider.
Rivaroxaban (Xarelto®)
What Is Rivaroxaban?
- Rivaroxaban is a blood thinner used to prevent and treat blood clots.
- It belongs to a group of medicines called direct oral anticoagulants (DOACs).
- It is commonly used to treat DVT (deep vein thrombosis) and PE (pulmonary embolism).
- It helps prevent existing clots from getting larger and reduces the risk of new clots forming.
How Is It Taken?
- Rivaroxaban is taken by mouth as a tablet.
- Depending on the reason you are taking it, it may be taken once or twice each day.
- For treatment of DVT or PE, it is usually taken twice daily for the first 21 days, then once daily thereafter.
- The 15 mg and 20 mg tablets should be taken with food to help your body absorb the medication properly.
- Try to take it at the same time(s) each day.
- Do not stop taking rivaroxaban unless instructed by your healthcare provider.
When Is Rivaroxaban Commonly Used?
- To treat a newly diagnosed DVT or PE.
- To prevent another DVT or PE after initial treatment.
- For many patients after hospital discharge.
- As a long-term treatment option for patients at continued risk for blood clots.
- As a convenient alternative to warfarin because routine blood testing is usually not required.
Benefits of Rivaroxaban
- Starts working quickly.
- Does not require routine INR blood tests.
- Has fewer food interactions than warfarin.
- Fixed dosing for most patients.
- Proven to be safe and effective for treating and preventing blood clots.
Important Safety Information
- Take exactly as prescribed.
- Do not skip doses.
- Missing doses can increase your risk of another blood clot.
- Do not stop the medication without talking to your healthcare provider.
- Tell your healthcare provider if you develop:
- Unusual bleeding
- Large or unexplained bruises
- Black or bloody stools
- Blood in urine
- Severe headache
- Dizziness or weakness
- Coughing up blood
Medication and Supplement Interactions
- Tell your healthcare provider about all medicines, vitamins, and supplements you take.
- Some medications can increase bleeding risk.
- Common examples include:
- Aspirin
- Ibuprofen (Advil®, Motrin®)
- Naproxen (Aleve®)
- Certain antibiotics and antifungal medications
- Some herbal supplements such as St. John's Wort
- Do not start new medications without discussing them with your healthcare provider.
Pregnancy and Breastfeeding
- Rivaroxaban is generally not recommended during pregnancy because there is limited safety information.
- Patients who become pregnant while taking rivaroxaban should contact their healthcare provider immediately.
- Enoxaparin (Lovenox®) is usually preferred during pregnancy.
- Discuss breastfeeding and anticoagulation options with your healthcare provider.
Before Procedures or Surgery
- Tell all healthcare providers and dentists that you take rivaroxaban.
- The medication may need to be stopped before surgery, dental work, or certain medical procedures.
- Never stop rivaroxaban without instructions from your healthcare provider.
Enoxaparin (Lovenox®)
- What Is Enoxaparin?
- Enoxaparin is a blood thinner that helps prevent and treat blood clots.
- It belongs to a group of medicines called low-molecular-weight heparins (LMWH).
- It is commonly used for patients with DVT (deep vein thrombosis) and PE (pulmonary embolism).
- It is often used in the hospital and sometimes continued at home.
- How Is It Given?
- Given as an injection under the skin (subcutaneous injection).
- Usually injected into the abdomen (belly area).
- Most patients receive it once or twice daily, depending on their treatment plan.
- Your healthcare team can teach you or a family member how to give the injections safely at home.
- When Is Enoxaparin Commonly Used?
- During initial treatment of PE or DVT.
- In pregnancy, because it is considered safe for both mother and baby.
- In patients with cancer-associated blood clots.
- When oral blood thinners are not appropriate.
- As a "bridge" when starting warfarin therapy.
- Benefits of Enoxaparin
- Works quickly to prevent clot growth.
- Does not require routine blood testing for most patients.
- Has fewer food and medication interactions than warfarin.
- Proven safe and effective in many patient populations.
- Important Safety Information
- Take exactly as prescribed.
- Do not skip doses.
- Rotate injection sites to reduce bruising.
- Mild bruising around the injection site is common.
- Tell your healthcare provider if you develop:
- Unusual bleeding
- Large bruises
- Black or bloody stools
- Blood in urine
- Severe headache
- Dizziness or weakness
- Pregnancy and Enoxaparin
- Enoxaparin is the preferred blood thinner for most pregnant patients with PE or DVT.
- It does not cross the placenta and does not harm the baby.
- Dosing may be adjusted during pregnancy based on weight and clinical factors.
- Your healthcare team will provide instructions on when to stop the medication before delivery and when to restart it afterward.
Heparin
- Given by IV or injection.
- Often used in the hospital.
Warfarin (Coumadin)
- Older blood thinner.
- Requires regular blood tests.
Important Safety Information for all blood thinners
Bleeding Precautions
- Blood thinners increase bleeding risk.
- Report unusual bleeding to your healthcare provider.
Take Medications Exactly as Prescribed
- Missing doses increases clot risk.
- Never stop treatment without medical advice.
Drug Interactions
- Some medications and supplements affect blood thinners.
- Always tell providers about all medicines you take.
Missed Dose Instructions
- Follow instructions from your healthcare team.
- Do not double up doses unless instructed.
Advanced Treatments for Severe PE
Hospital-Based Therapies
Clot-Busting Medications
- Used for life-threatening PE.
- Help dissolve large clots quickly.
Catheter-Directed Therapy
- A small tube is placed into the clot.
- Medication or devices help remove the clot.
Mechanical Thrombectomy
- Specialized devices physically remove the clot.
- Used in selected patients.
Inferior Vena Cava Filter
- Temporary filter placed in the inferior vein to prevent clots from traveling to the lungs from the lower body.
- Typically used when a patient cannot have anticoagulation.
ICU Care
- Needed for severe PE with unstable blood pressure.
- Allows continuous monitoring and rapid treatment.
Supportive Care
Oxygen Therapy
- Helps improve oxygen levels.
Blood Pressure Support
- Medications may help maintain blood pressure.
Heart Monitoring
- Continuous monitoring checks for complications.
