Anticoagulation Clinic

Anticoagulation Clinic

Location Information

Mount Nittany Medical Center
Lance and Ellen Shaner Cancer Pavilion
1800 East Park Avenue
State College, PA 16803

Phone: 814.234.6180
Fax: 814.234.6775
Email: ACClinic@mountnittany.org

The Mount Nittany Medical Center Pharmacy operates a state-of-the-art anticoagulation clinic here in the Centre region.

Currently located in Mount Nittany Medical Center's Lance and Ellen Shaner Cancer Pavilion, our pharmacists work in conjunction with your physician to monitor and manage your anticoagulation therapy.

All of our pharmacists are trained in anticoagulation management, so they can provide our patients the individualized care that anticoagulant therapy requires.

Our anticoagulation clinic operates instruments that require only a fingerstick of blood to measure your PT/INR. Lab results are obtained immediately.

Anticoagulation COEPatient management is a "one stop" procedure: patients receive their results, dosing instruction, prescription refill and follow up visit appointment all at the same time, all within minutes.

Disclaimer: This site is for informational purposes only and does not, itself, constitute medical advice. It is not a replacement for careful medical judgements by qualified medical personnel. There may be information in the site that does not apply to or may be inappropriate for the medical situation at hand.
How to prepare for your visit

How long will it take?

Your first appointment will take about 1 hour. You should plan to arrive about 10 minutes before your first appointment so that you can register for your AC Clinic visit at the Lance and Ellen Shaner Cancer Pavilion reception desk (Patient Registration). Appointments after that will likely take less time (15-30 minutes). All clinic visits are by appointment. We will schedule your follow-up appointment at the end of each visit.

What happens when I come in?

At the first visit, we will take a brief medical history and explain how our service operates. At your other visits, we will ask you about any possible side effects that you may be having and also make sure there have not been any changes in your overall health or other medications. If you take warfarin (Coumadin), we will check your INR at each visit. Your INR is a measure of how well the warfarin (Coumadin) is working. The INR is measured by doing a quick fingerstick and obtaining a drop of blood. Your result is back in less than a minute! The clinic pharmacist will use your INR value to decide whether you will need to change the amount of medication you take. If you take other anticoagulants, a blood draw may be required.

How often do I need to come in for an appointment?

If you are just beginning your warfarin (Coumadin) therapy, you will need to come into the clinic one or two times a week to test your INR. The reason is that each patient responds to warfarin (Coumadin) differently and it is important to find the right dose for you. You will need to come in less often (sometimes once a month or longer) when your warfarin (Coumadin) dose becomes stable or if you take another anticoagulant. If you are already taking warfarin (Coumadin), we will determine how frequently you need to come in based on your previous history of INR and dose adjustments. All patients who go on other medications that can affect how warfarin (Coumadin) works may be asked to come in more frequently.

Where do I go?

Come to Entrance E of the main hospital building, which is the Lance and Ellen Shaner Cancer Pavilion Entrance. Tell the reception desk (patient registration) personnel that you are here for your first visit to the Pharmacy Anticoagulation Clinic. If you are unable to keep your appointment, please call Central Scheduling at (814) 234-6106 to reschedule as soon as possible. Failure to keep appointments and follow instructions can result in serious health risks and/or termination from our program.

What should I bring?

Bring a list of current medications and their doses, your physician’s order for treatment (if given to you), your insurance card(s), and a Photo ID. If the patient is a minor (under 18 years of age), a parent or guardian must come to authorize treatment.

What questions should I expect to be asked at each visit?

  • Am I taking the correct dose (correct strength on the correct days of the week)?
  • Do I have any changes in my general health status?
  • Any changes in diet, especially intake of vitamin-K (“greens”) or alcohol (if taking warfarin)?
  • Have I started or stopped any prescription medications since last seen?
  • Do I have any unusual bruising of bleeding?
  • Do I have any signs of clotting?
  • Have I had any emergency department visits or hospitalizations since last seen?
  • Have I started or stopped any over-the-counter vitamins, herbal supplements, dietary supplements or pain relievers?
  • Do I have any procedures or surgery scheduled in the near future?
  • Do I have any travel plans that will interfere with my visits?

What will I learn about warfarin (Coumadin® /Jantoven) at my visit?

  • What is anticoagulation and how does it work?
  • Why do I need to start taking warfarin?
  • How do I take warfarin (time of day, dose, weekly schedule, etc.)?
  • How is warfarin monitored (INR testing, goal INR range for me, how often is testing)?
  • What are the risks and side-effects of warfarin?
  • What are the signs/symptoms of bleeding or clotting to watch for?
  • What are the main factors influencing INR (dietary intake of vitamin-K, general health, activity level, alcohol, other medications/supplements, etc.)
  • What are the drug-food interactions to watch for (vitamin-K rich foods, alcohol)?
  • What are some other necessary lifestyle changes (no contact sports, fall avoidance, pregnancy)?
  • When to seek immediate medical attention?

What will I learn about DOACs at my visit?

  • What is anticoagulation and how do DOACs work?
  • If I was on warfarin in the past, how are DOACs different from warfarin?
  • Why do I need to start taking a DOAC?
  • How long is my treatment with a DOAC?
  • How do I take the DOAC (dose, frequency, timing, with food)?
  • Why is it important not to skip doses?
  • What are the signs/symptoms of bleeding or clotting to watch for?
  • What are other drug-drug interactions to watch for?
  • What kind of lab monitoring will need to be done and how often?
  • What to do about taking DOACs when procedures or surgeries are scheduled?
  • How to store DOACs?
  • What are some other necessary lifestyle changes?
  • When and how to notify AC Clinic?

Drug education

Warfarin (Coumadin/Jantoven)

Enoxaparin (Lovenox) (Low-Molecular Weight Heparin)

To reduce your bleeding and clotting risk it is important that you attend follow-up appointments with your provider, and have blood tests done as your provider orders.

What is Low Molecular Weight Heparin?
Low molecular weight heparin (LMWH) is a medication that is a subcutaneous injection (like insulin) that thins the blood. It helps prevent blood clots from forming in the veins and treats blood clots already present in the veins by preventing the blood clot from extending or getting larger. LMWH is generally used for a short period of time for anticoagulation (blood thinning), while slower acting meds like warfarin (Coumadin, Jantoven) a blood thinner in pill form take some time to work to its fullest potential.

It can be given once or twice a day by a simple injection under the skin. The patient or family member can be taught to give the injection. The use of LMWH has allowed patients with blood clots to be treated at home, or with only a short hospital stay in some cases.

What are the side effects?
The major side effect associated with LMWH, as with any blood thinner, is bleeding. You must notify your doctor if you have any unusual bleeding, for example, heavy nosebleeds, bleeding gums, vomiting blood, blood in bowel movements, or heavy vaginal bleeding. LMWH can cause local irritation or inflammation (tenderness and redness) at the injection site. Call your doctor if you develop any generalized rash or reaction.

What else do I need to know?

There are no restrictions to diet or foods that you eat with the use of LMWH.

If you miss a dose within 2 hours of your normal dosing time, it is OK to take your LMWH dose, otherwise, just skip the missed dose and resume at your next normal dosing time.

You should avoid the use of any other medications which may increase your risk of bleeding while you are on LMWH. Some of these medications includes aspirin, nonsteroidal anti-inflammatory medications (ibuprofen, naproxen, etc.), COX-II Inhibitors (celecoxib or Celebrex), as well as some herbal medications/supplements which can cause blood thinning. Always consult your anticoagulation clinic before you begin any new medication, including any over the counter medications. Notify all of your medical providers (dentist, podiatrist, gynecologist, chiropractor, etc.) that you are on a blood thinning medication.

Click here to view subcutaneous self-injection directions.

Reference: The content is based on available evidence-based guidelines and resources. Much of this content is produced by the Michigan Anticoagulation Quality Improvement Initiative (MAQI2), a consortium of anticoagulation clinics and experts from across the state of Michigan. Last revised 07/2019. https://anticoagulationtoolkit.org/sites/default/files/toolkit_pdfs/patient/NewerAgents/doacs/LowMolecularWeightHeparin2019_Final.pdf from 11/7/19

Direct-Acting Oral Anticoagulants (DOACs)

Apixaban (Eliquis)

To reduce your bleeding and clotting risk, it is important that you attend follow up appointments with your doctor or anticoagulation clinic, and have blood tests done as your providers order.

What is apixaban (Eliquis)?
Apixaban is also called Eliquis.  Apixaban (Eliquis) is used to reduce the risk of blood clots and stroke in people with an abnormal heart rhythm known as atrial fibrillation, in people who have had a blood clot, or in people who have undergone orthopedic surgery.

  • Blood clots can block a blood vessel cutting off blood supply to the area.
  • Rarely, clots can break into pieces and travel in the blood stream, lodging in the heart (causing a heart attack), the lungs (causing a pulmonary embolus), or in the brain (causing a stroke).

If you were previously on warfarin (Coumadin/Jantoven) AND you are starting Apixaban (Eliquis) do not continue taking warfarin. Apixaban (Eliquis) replaces warfarin/Coumadin.

How should I take apixaban (Eliquis)?
Take Apixaban (Eliquis) exactly as prescribed by your doctor. Apixaban (Eliquis) may be taken with or without food.

  • If you missed a dose: Take it as soon as you remember on the same day. Do not double a dose to make up for a missed dose.
  • Do not stop taking apixaban (Eliquis) suddenly without telling your doctor. This can put you at risk of having a stroke or a blood clots.
  • If you take too much apixaban (Eliquis), call your anticoagulation clinic. If you are experiencing any bleeding which you cannot get to stop, go to the nearest emergency room.

How should I store apixaban (Eliquis)?
Store at room temperature in a dry area (avoid storing it in the bathroom).

What should I know about apixaban (Eliquis)?
Apixaban (Eliquis) can increase your risk of bleeding because it lessens your body’s ability to clot. While you take Apixaban (Eliquis), you may bruise more easily and it may take longer for bleeding to stop. Apixaban (Eliquis) can cause bleeding which can be serious. You may have a higher risk of bleeding if you take Apixaban (Eliquis) and:

  • You are over 75 years old
  • You have kidney problems
  • You have stomach or intestine bleeding that is recent or recurs, or have a stomach ulcer.
  • You take other medications that increase your risk of bleeding, including:
    • Aspirin or products that contain aspirin
    • Long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) including ibuprofen and naproxen
    • Clopidogrel (Plavix), prasugrel (Effient), or ticagrelor (Brilinta)
    • Any medicine that contains heparin or any another blood thinner

What are the potential side effects of apixaban (Eliquis)?
Apixaban (Eliquis) can increase your risk of bleeding because it lessens your body’s ability to clot. While you take apixaban (Eliquis), you may bruise more easily and it may take longer for bleeding to stop. In some people, apixaban (Eliquis) can cause symptoms of an allergic reaction, including hives, rash, and itching. Seek medical attention right away if you get any of the following symptoms of a serious allergic reaction:

  • Chest pain or chest tightness
  • Swelling of your face or tongue
  • Trouble breathing or wheezing
  • Feeling dizzy or faint

When should I call my anticoagulation clinic?

  • If you start or stop any medications, including over-the-counter medications or herbal supplements. These may affect the way apixaban works.
  • You are having a surgery or procedure as you may need to stop taking apixaban for a short period of time before your procedure. Do not stop taking apixaban (Eliquis) without first talking with your doctor.
  • You need a medication refill (notify them before you are out of apixaban so you do not run out).
  • If you are unable to afford apixaban
  • If you experience any unexpected bleeding or bleeding that lasts a long time, such as:
    • Unusual bleeding from the gums
    • Nose bleeds that happen often
    • Menstrual bleeding or vaginal bleeding that is heavier than normal
    • Bruises that happen without a known cause or get larger

When should I seek emergency medical help?
Call 911 immediately if you experience any of the following serious conditions:

  • If you experience any of the following signs and symptoms of bleeding:
    • Bleeding that is severe or bleeding that you cannot control
    • Pink or brown urine
    • Red or black stools (that look like tar)
    • Coughing up blood or blood clots
    • Vomiting up blood or if your vomit looks like “coffee grounds”
  • If you experience any of the following signs and symptoms of a stroke:
    • Dizziness, sudden loss of vision, or sudden severe headache
    • Numbness or weakness in any limb
    • Difficulty speaking or slurred speech
    • Drooping on one side of your face
  • If you experience any of the following signs and symptoms of blood clots:
    • Sudden severe shortness of breath, chest pain
    • Swelling, redness, heat, or pain in any limb

Dabigatran (Pradaxa)

To reduce your bleeding and clotting risk, it is important that you attend follow up appointments with your doctor or anticoagulation clinic, and have blood tests done as your providers order.

What is dabigatran (Pradaxa)?
Dabigatran is also called Pradaxa®. Dabigatran (Pradaxa) is used to reduce the risk of blood clots and stroke in people with an abnormal heart rhythm known as atrial fibrillation, or in people who have had a blood clot.

  • Blood clots can block a blood vessel cutting off blood supply to the area.
  • Rarely, clots can break into pieces and travel in the blood stream, lodging in the heart (causing a heart attack), the lungs (causing a pulmonary embolus), or in the brain (causing a stroke).

If you were previously on warfarin and you are starting dabigatran (Pradaxa) do not continue taking warfarin/Coumadin/Jantoven. Dabigatran (Pradaxa) replaces warfarin/Coumadin/Jantoven.

How should I take Dabigatran (Pradaxa)?
Take Dabigatran (Pradaxa®) exactly as prescribed by your doctor. Dabigatran (Pradaxa®) may be taken with or without food. Swallow the capsule whole. Do not break, chew, or empty the pellets from the capsule. If you missed a dose:

  • If your next dose is more than 6 hours away: take the dose as soon as you remember.
  • If your next dose is less than 6 hours away: skip the missed dose and resume your normal dosing schedule.
  • Do not take a double dose of dabigatran to make up for a missed dose.

Do not stop taking dabigatran (Pradaxa) suddenly without telling your doctor. This can put you at risk of having a stroke or a blood clot. If you take too much dabigatran (Pradaxa), call your doctor or the anticoagulation clinic. If you are experiencing any bleeding which you cannot get to stop, go to the nearest emergency room.

How should I store dabigatran (Pradaxa)?
Dabigatran (Pradaxa) may be dispensed in a bottle or in individually, separated doses (known as blisterpacks). It is very important to:

  • Keep the medication in its original container to protect it from moisture.
  • Do NOT store or place dabigatran capsules in any other container, such as pill boxes or pill organizers.

Store at room temperature in a dry area (avoid storing it in the bathroom).

What should I know about dabigatran (Pradaxa)?
Dabigatran (Pradaxa) can increase your risk of bleeding because it lessens your body’s ability to clot. While you take dabigatran (Pradaxa), you may bruise more easily and it may take longer for bleeding to stop. Dabigatran (Pradaxa) can cause bleeding which can be serious. You may have a higher risk of bleeding if you take dabigatran (Pradaxa) and:

  • You are over 75 years old
  • You have kidney problems
  • You have stomach or intestine bleeding that is recent or recurs, or have a stomach ulcer.
  • You take other medications that increase your risk of bleeding, including:
    • Aspirin or products that contain aspirin
    • Long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) including ibuprofen and naproxen.
    • Clopidogrel (Plavix), prasugrel (Effient), or ticagrelor (Brilinta)
    • Any medicine that contains heparin or any another blood thinner

What are the potential side effects of dabigatran (Pradaxa)?
Dabigatran (Pradaxa) can increase your risk of bleeding because it lessens your body’s ability to clot. While you take dabigatran (Pradaxa), you may bruise more easily and it may take longer for bleeding to stop. Common side effects include stomach pain, upset stomach, or heartburn. In some people, dabigatran (Pradaxa) can cause symptoms of an allergic reaction, including hives, rash, and itching. Seek medical attention right away if you get any of the following symptoms of a serious allergic reaction:

  • Chest pain or chest tightness
  • Swelling of your face or tongue
  • Trouble breathing or wheezing
  • Feeling dizzy or faint

When should I call my doctor or anticoagulation clinic?

  • If you start or stop any medications, including over-the-counter medications or herbal supplements. These may affect the way dabigatran (Pradaxa) works.
  • You are having a surgery or procedure as you may need to stop taking dabigatran (Pradaxa) for a short period of time before your procedure. Do not stop taking dabigatran without first talking with your doctor.
  • You need a medication refill (notify them before you are out of dabigatran (Pradaxa) so you do not run out).
  • If you are unable to afford dabigatran (Pradaxa)
  • If you experience any unexpected bleeding or bleeding that lasts a long time, such as:
    • Unusual bleeding from the gums
    • Nose bleeds that happen often
    • Menstrual bleeding or vaginal bleeding that is heavier than normal
    • Bruises that happen without a known cause or get larger

When should I seek emergency medical help?
Call 911 immediately if you experience any of the following serious conditions:

If you experience any of the following signs and symptoms of bleeding:

  • Bleeding that is severe or bleeding that you cannot control
  • Pink or brown urine
  • Red or black stools (that look like tar)
  • Coughing up blood or blood clots
  • Vomiting up blood or if your vomit looks like “coffee grounds”

If you experience any of the following signs and symptoms of a stroke:

  • Dizziness, sudden loss of vision, or sudden severe headache
  • Numbness or weakness in any limb
  • Difficulty speaking or slurred speech
  • Drooping on one side of your face

If you experience any of the following signs and symptoms of blood clots:

  • Sudden severe shortness of breath, chest pain
  • Swelling, redness, heat, or pain in any limb

Edoxaban (Savaysa®)

To reduce your bleeding and clotting risk, it is important that you attend follow up appointments with your doctor or anticoagulation clinic, and have blood tests done as your providers order.

What is Edoxaban (Savaysa)?
Edoxaban is also called Savaysa. Edoxaban (Savaysa) is used to reduce the risk of blood clots and stroke in people with an abnormal heart rhythm known as atrial fibrillation.

  • Blood clots can block a blood vessel cutting off blood supply to the area.
  • Rarely, clots can break into pieces and travel in the blood stream, lodging in the heart (causing a heart attack), the lungs (causing a pulmonary embolus), or in the brain (causing a stroke).

If you were previously on warfarin and you are starting edoxaban (Savaysa), do not continue taking warfarin (Coumadin/Jantoven). Edoxaban (Savaysa) replaces warfarin/Coumadin/Jantoven.

How should I take edoxaban (Savaysa)?
Take edoxaban (Savaysa) exactly as prescribed by your doctor. Edoxaban (Savaysa) may be taken with or without food. If you missed a dose:

  • Take it as soon as you remember on the same day. Do not double a dose to make up for a missed dose.

Do not stop taking edoxaban (Savaysa) suddenly without telling your doctor or anticoagulation clinic. This can put you at risk of having a stroke or a blood clot. If you take too much edoxaban (Savaysa), call your doctor or anticoagulation clinic. If you are experiencing any bleeding which you cannot get to stop, go to the nearest emergency room.

How should I store edoxaban (Savaysa)?
Store at room temperature in a dry area (avoid storing it in the bathroom).

What should I know about edoxaban (Savaysa)?
Edoxaban (Savaysa) can increase your risk of bleeding because it lessens your body’s ability to clot. While you take edoxaban, you may bruise more easily and it may take longer for bleeding to stop. Edoxaban (Savaysa) can cause bleeding which can be serious. You may have a higher risk of bleeding if you take edoxaban (Savaysa) and:

  • You are over 75 years old
  • You have kidney problems
  • You have stomach or intestine bleeding that is recent or recurs, or have a stomach ulcer.
  • You take other medications that increase your risk of bleeding, including:
    • Aspirin or products that contain aspirin
    • Long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) including ibuprofen and naproxen.
    • Clopidogrel (Plavix), prasugrel (Effient), or ticagrelor (Brilinta)
    • Any medicine that contains heparin or any another blood thinner

What are the potential side effects of edoxaban (Savaysa)?
Edoxaban(Savaysa®) can increase your risk of bleeding because it lessens your body’s ability to clot. While you take edoxaban, you may bruise more easily and it may take longer for bleeding to stop. In some people, edoxaban can cause symptoms of an allergic reaction, including hives, rash, and itching. Seek medical attention right away if you get any of the following symptoms of a serious allergic reaction:

  • Chest pain or chest tightness
  • Swelling of your face or tongue
  • Trouble breathing or wheezing
  • Feeling dizzy or faint

When should I call my doctor or anticoagulation clinic?

  • If you start or stop any medications, including over-the-counter medications or herbal supplements. These may affect the way edoxaban (Savaysa) works.
  • You are having a surgery or procedure as you may need to stop taking edoxaban (Savaysa) for a short period of time before your procedure. Do not stop taking edoxaban (Savaysa) without first talking with your doctor or anticoagulation clinic.
  • You need a medication refill (notify them before you are out of edoxaban (Savaysa) so you do not run out).
  • If you are unable to afford edoxaban (Savaysa)
  • If you experience any unexpected bleeding or bleeding that lasts a long time, such as:
    • Unusual bleeding from the gums
    • Nose bleeds that happen often
    • Menstrual bleeding or vaginal bleeding that is heavier than normal
    • Bruises that happen without a known cause or get larger

When should I seek emergency medical help?
Call 911 immediately if you experience any of the following serious conditions:

  • If you experience any of the following signs and symptoms of bleeding:
    • Bleeding that is severe or bleeding that you cannot control
    • Pink or brown urine
    • Red or black stools (that look like tar)
    • Coughing up blood or blood clots
    • Vomiting up blood or if your vomit looks like “coffee grounds”
  • If you experience any of the following signs and symptoms of a stroke:
    • Dizziness, sudden loss of vision, or sudden severe headache
    • Numbness or weakness in any limb
    • Difficulty speaking or slurred speech
    • Drooping on one side of your face
  • If you experience any of the following signs and symptoms of blood clots:
    • Sudden severe shortness of breath, chest pain
    • Swelling, redness, heat, or pain in any limb

Rivaroxaban (Xarelto)

To reduce your bleeding and clotting risk, it is important that you attend follow up appointments with your doctor or anticoagulation clinic, and have blood tests done as your providers order.

What is rivaroxaban (Xarelto)?
Rivaroxaban is also called Xarelto. Rivaroxaban (Xarelto) is used to reduce the risk of blood clots and stroke in people with an abnormal heart rhythm known as atrial fibrillation, in people who have had a blood clot, or in people who have undergone orthopedic surgery.

  • Blood clots can block a blood vessel cutting off blood supply to the area.
  • Rarely, clots can break into pieces and travel in the blood stream, lodging in the heart (causing a heart attack), the lungs (causing a pulmonary embolus), or in the brain (causing a stroke).

If you were previously on warfarin/Coumadin/Jantoven and you are starting rivaroxaban (Xarelto), do not continue taking warfarin/Coumadin/Jantoven. Rivaroxaban (Xarelto) replaces warfarin.

How should I take rivaroxaban (Xarelto)?
Take rivaroxaban (Xarelto) exactly as prescribed by your doctor.

Rivaroxaban (Xarelto) should be taken WITH FOOD (generally the largest meal of the day).

Rivaroxaban (Xarelto) tablets may be crushed and mixed with applesauce to make the tablet easier to swallow.

  • If you missed a dose: Take it as soon as you remember on the same day.

Do not stop taking rivaroxaban suddenly without telling your doctor or anticoagulation clinic. This can put you at risk of having a stroke or a blood clot. If you take too much rivaroxaban, call your doctor or anticoagulation clinic. If you are experiencing any bleeding which you cannot get to stop, go to the nearest emergency room.

How should I store rivaroxaban (Xarelto)?
Store at room temperature in a dry area (avoid storing it in the bathroom).

What should I know about rivaroxaban (Xarelto)?
Rivaroxaban (Xarelto) can increase your risk of bleeding because it lessens your body’s ability to clot. While you take rivaroxaban (Xarelto), you may bruise more easily and it may take longer for bleeding to stop. Rivaroxaban (Xarelto) can cause bleeding which can be serious. You may have a higher risk of bleeding if you take rivaroxaban (Xarelto) and:

  • You are over 75 years old
  • You have kidney problems
  • You have stomach or intestine bleeding that is recent or recurs, or have a stomach ulcer.
  • You take other medications that increase your risk of bleeding, including:
    • Aspirin or products that contain aspirin
    • Long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) including ibuprofen and naproxen.
    • Clopidogrel (Plavix), prasugrel (Effient), or ticagrelor (Brilinta)
    • Any medicine that contains heparin or any another blood thinner

What are the potential side effects of Rivaroxaban (Xarelto)?
Rivaroxaban (Xarelto) can increase your risk of bleeding because it lessens your body’s ability to clot. While you take rivaroxaban, you may bruise more easily and it may take longer for bleeding to stop. In some people, rivaroxaban (Xarelto) can cause symptoms of an allergic reaction, including hives, rash, and itching. Seek medical attention right away if you get any of the following symptoms of a serious allergic reaction:

  • Chest pain or chest tightness
  • Swelling of your face or tongue
  • Trouble breathing or wheezing
  • Feeling dizzy or faint

When should I call my doctor or anticoagulation service?

  • If you start or stop any medications, including over-the-counter medications or herbal supplements. These may affect the way rivaroxaban (Xarelto) works.
  • You are having a surgery or procedure as you may need to stop taking rivaroxaban (Xarelto) for a short period of time before your procedure. Do not stop taking rivaroxaban (Xarelto) without first talking with your doctor.
  • You need a medication refill (notify them before you are out of rivaroxaban (Xarelto) so you do not run out).
  • If you are unable to afford rivaroxaban (Xarelto)
  • If you experience any unexpected bleeding or bleeding that lasts a long time, such as:
    • Unusual bleeding from the gums
    • Nose bleeds that happen often
    • Menstrual bleeding or vaginal bleeding that is heavier than normal
    • Bruises that happen without a known cause or get larger

When should I seek emergency medical help?
Call 911 immediately if you experience any of the following serious conditions:

  • If you experience any of the following signs and symptoms of bleeding:
    • Bleeding that is severe or bleeding that you cannot control
    • Pink or brown urine
    • Red or black stools (that look like tar)
    • Coughing up blood or blood clots
    • Vomiting up blood or if your vomit looks like “coffee grounds”
  • If you experience any of the following signs and symptoms of a stroke:
    • Dizziness, sudden loss of vision, or sudden severe headache
    • Numbness or weakness in any limb
    • Difficulty speaking or slurred speech
    • Drooping on one side of your face
  • If you experience any of the following signs and symptoms of blood clots:
    • Sudden severe shortness of breath, chest pain
    • Swelling, redness, heat, or pain in any limb

Reference: The content is based on available evidence-based guidelines and resources. Much of this content is produced by the Michigan Anticoagulation Quality Improvement Initiative (MAQI2), a consortium of anticoagulation clinics and experts from across the state of Michigan. Last revised 07/2019. https://anticoagulationtoolkit.org/sites/default/files/toolkit_pdfs/patient/NewerAgents/doacs/Rivaroxaban2019_Final.pdf from 11/7/19

Blood thinners

Living your best life with blood thinners

Taking care of nosebleeds

How can I prevent nosebleeds?
Preventative care is the most important step when it comes to managing nosebleeds. You can buy products used to treat and prevent nosebleeds at your local pharmacy.

  • It is important to keep your nose moist during the dry months of winter. Some ways to keep your nose moist include:
  • Use an over-the-counter saline nasal spray every 2-3 hours as while awake.
  • Use a cool mist humidifier to humidify your room at night while you sleep
  • Coat the inside of your nostril with petroleum jelly (Vaseline) twice daily, especially at night. You can also place a cotton ball lightly coated in petroleum jelly in the affected nostril overnight.

What can I do when I have a nosebleed?
Nosebleeds can happen at any time, particularly during the cold dry months of winter. While they can be a nuisance, they are rarely an emergency. Over the counter nasal decongestant spray is very effective at stopping nose bleeds, so it is a good idea to keep a bottle on hand. When you have a nosebleed:

  • Remain calm
  • Sit or stand up and lean forward. If there is blood in your mouth, spit it out. Do NOT swallow it.
  • Apply 3 sprays of decongestant nose spray (oxymetazoline/Afrin) into the side that is bleeding.
  • Gently pinch the soft part of your nose shut.
  • Gently pinch your nose for 10 minutes. Use a clock to keep track of time. Resist the urge to peek after a few minutes to see if your nose has stopped bleeding.
  • After 10 mins, let go of your nose. If it is still bleeding, soak a cotton ball with the nasal spray. Place the cotton ball into the bleeding nostril fnd gently pinch for another 10 minutes. Again, use a clock to keep track of the time.
  • Once bleeding has stopped, for 2 days:
    • Do NOT blow your nose
    • Do NOT lift anything heavy or do heavy housework
  • Check your blood pressure, if possible. High blood pressure can cause nosebleeds.

Can I keep using steroid nasal sprays?
If you use steroid nasal sprays, call your doctor and ask if you need to continue them. Steroid sprays can dry out your nose and increase your risk for more nosebleeds.

  • Remember, using nasal saline spray and petroleum jelly are the best tools for preventing nosebleeds.

When should I contact my Anticoagulation provider?
It is important to contact the anticoagulation clinic about your nosebleed. We may want to do a blood test to find out if there have been any other changes in your health. Let your anticoagulation clinic know if you have more than 3-4 nosebleeds a week or 6 in a month despite following these tips. If you continue to have nosebleeds, you may need an evaluation by an Ear, Nose and Throat (ENT) specialist.

When should I go to the emergency room?
Nosebleeds are a nuisance but rarely an emergency. There are some situations when nosebleeds require immediate medical attention:

  • Bleeding that does not stop in 30 minutes
  • Bleeding that is very heavy, pouring down the back of your throat and out the front of your nose
  • Bleeding with other symptoms like:
    • very high blood pressure
    • light headedness
    • chest pain
    • rapid heart rate that may require treatment

Remember, nosebleeds are common in patients on blood thinners and can be scary the first time they happen. Nosebleeds are rarely dangerous and can usually be easily managed at home if you know what to do and when to seek help. To view a video about taking care of a nosebleed:

  • visit: careguides.med.umich.edu/
  • In the search box type “nose bleed video” and hit Search
  • Click the title to view the video.

Reference: The content is based on available evidence-based guidelines and resources. Much of this content is produced by the Michigan Anticoagulation Quality Improvement Initiative (MAQI2), a consortium of anticoagulation clinics and experts from across the state of Michigan. Last revised 06/2017. https://anticoagulationtoolkit.org/sites/default/files/toolkit_pdfs/patient/handouts/NoseBleedsBloodThinners2017(MAQI).pdf from 11/7/19

Blood in stool, urine, or vagina - what do I do?

Unexpected bleeding in your stool or urine or from your vagina can be caused by a variety of medical conditions as well as certain medications, including blood thinners. It is important to notify your healthcare provider and anticoagulation clinic about any bleeding from these locations. A trip to the emergency room may not be necessary, UNLESS the bleeding is significant OR if you have other unusual symptoms.

What should I do if I have bleeding from these locations?

  1. The first thing to do is determine how serious the bleeding is and if you are having any serious symptoms.
  2. Use the information below to help determine if you should seek immediate medical attention or if it is only necessary to call your healthcare provider and anticoagulation clinic.

**For information on symptoms and who to call for rectal, urinary and vaginal bleeding see below…

Rectal bleeding (blood in stool):
Get immediate medical attention if you have:

  • Black, tarry stools or maroon colored stools
  • Bright red blood in the toilet water

Call healthcare providers and anticoagulation clinic if you have:

  • Small amount of blood on toilet paper
  • No other unusual symptoms

How can I prevent rectal bleeding?
One of the most common causes of blood in the stool is constipation and/or hemorrhoids. Here are some suggestions to help prevent constipation and/or hemorrhoids:

  • Eat a healthy, high-fiber diet and drink plenty of water
  • Do not strain when having a bowel movement. Ask your doctor about a stool softener or a laxative that is safe to use
  • Do not use harsh enemas, suppositories or any harsh laxatives that could cause rectal bleeding
  • Try to get regular exercise

Urinary bleeding (blood in urine):
Get immediate medical attention if you have:

  • Urine with extensive blood clots
  • Urine that is red and thicker like ketchup
  • Difficulty urinating
  • Severe pain

Call healthcare providers and anticoagulation clinic if you have:

  • Light pink or brownish colored urine without extensive blood clots
  • No other unusual symptoms such as difficulty urinating or pain

Vaginal bleeding:
Get immediate medical attention if you have:

  • Bleeding enough to soak a pad or more an hour for more than 2 hours

Call healthcare providers and anticoagulation clinic if you have:

  • Periods that are a little heavier or last a little longer than usual
  • No other unusual symptoms

Regardless of how severe the bleeding is, you must do the following:

1. Get immediate medical attention if you have:

  • Dizziness
  • Light-headedness
  • Shortness of breath
  • Fatigue
  • Any other unusual symptom

2. Call your healthcare provider and anticoagulation clinic. You may need to have your INR tested, and further testing may be needed to determine the cause of the bleed.

Reference: The content is based on available evidence-based guidelines and resources. Much of this content is produced by the Michigan Anticoagulation Quality Improvement Initiative (MAQI2), a consortium of anticoagulation clinics and experts from across the state of Michigan. Last revised 07/2017. https://anticoagulationtoolkit.org/sites/default/files/toolkit_pdfs/patient/handouts/GIGUBleeding2017(MAQI).pdf from 11/7/19

Taking care of a cut

What do I do when I cut myself at home?
Minor injuries to the skin are common but rarely an emergency. In patients on blood thinners, it often takes longer than normal for the bleeding to stop. Most of the time, bleeding can be stopped by following the steps below:

  • Remain calm
  • Hold direct pressure over the cut with gauze or a clean rag
  • Elevate the cut so that it is above your heart
  • After 15 minutes of continuous pressure, check to see if the cut is still bleeding. If STILL bleeding, apply an over-the-counter product to seal the woulnd and stop the bleeding.

Make sure you have an over-the-counter styptic(anti-bleeding) powder available at all times to stop bleeding. This over-the-counter powder effectively stops bleeding in patients on blood thinners. See your local pharmacist for more information.

When should I go to the Emergency Room or contact 911?
Seek immediate attention:

  • If the wound is bleeding heavily, large, deep, and/or dirty
  • If the wound doesn’t stop bleeding after following the instructions above and holding pressure for 30 minutes
  • If you have other concerning symptoms such as numbness or severe pain
  • If signs of infection develop such as redness, swelling, or pus drainage

If you go to emergency room, tell the nurse or doctor that you are taking a blood thinner.

When should I contact my Anticoagulation provider?
Please call the Anticoagulation Clinic at 814.234.6180 if you have any questions.

Reference: The content is based on available evidence-based guidelines and resources. Much of this content is produced by the Michigan Anticoagulation Quality Improvement Initiative (MAQI2), a consortium of anticoagulation clinics and experts from across the state of Michigan. Last revised 06/2017. https://anticoagulationtoolkit.org/sites/default/files/toolkit_pdfs/patient/handouts/CutsBloodThinners2017(MAQI).pdf from 11/7/19

Taking care of bruises

What can I do to take care of my bruises at home?
Bruising is common in patients taking blood thinners. Most of the time, bruising is not an emergency situation and can be treated at home by following these steps:

  • Rest and protect the bruised area
  • Ice will reduce pain and swelling. Apply ice or cold packs immediately to prevent or minimize swelling. Apply ice or cold pack for 10-20 minutes, 3 or more times a day.
    • For the first 48 hours after an injury, avoid things that might increase swelling, such as hot showers, hot tubs, hot packs, or alcoholic beverages.
    • After 48-72 hours, if swelling is gone, apply heat and begin gentle exercise with the aid of moist heat to help restore and maintain flexibility.  Some experts recommend alternating between hot and cold treatments.
  • Elevate the bruised area on pillows while applying ice and anytime you are sitting or lying down. Try to keep the area at or above the level of your heart to help minimize swelling.
    • Gently massage or rub the area to relieve pain and encourage blood flow. Do NOT massage the bruised area if it causes pain or discomfort.

When should I call my doctor?
Call your doctor and anticoagulation clinic if any of the following occur during home treatment:

  • A bruise that lasts longer than two weeks
  • Signs of skin infection developing, such as:
    • Increased pain
    • Swelling
    • Warmth
    • Redness around the area
    • Red streaks leading from the area
    • Pus and a fever
  • Symptoms that become more severe or frequent
  • New symptoms develop

When should I contact my Anticoagulation provider?
It is important to contact your anticoagulation clinic about your bruising, especially if the bruising is new or more significant than usual. They may want to do a blood test or to find out if there have been any other changes in your health. Please call the anticoagulation clinic at 814.234.6176 if you have any questions.

 

Reference:
The content is based on available evidence-based guidelines and resources.  Much of this content is produced by the Michigan Anticoagulation Quality Improvement Initiative (MAQI2), a consortium of anticoagulation clinics and experts from across the state of Michigan.  Last revised 06/2017. https://anticoagulationtoolkit.org/sites/default/files/toolkit_pdfs/patient/handouts/BruisesBloodThinners2017(MAQI).pdf  from 11/7/19

Disclaimer: This site is for informational purposes only and does not, itself, constitute medical advice. It is not a replacement for careful medical judgements by qualified medical personnel. There may be information in the site that does not apply to or may be inappropriate for the medical situation at hand.

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