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Warfarin, apixaban (Eliquis), dabigatran (Pradaxa) and rivaroxaban (Xarelto) - anticoagulants and how to take them

Warfarin, apixaban (Eliquis), dabigatran (Pradaxa) and rivaroxaban (Xarelto) are anti-clotting medicines used to lower the risk of harmful blood clots. If you are prescribed one of these, it is important that you know how to use it safely and correctly, to avoid side effects, especially bleeding.

4 min read

What are warfarin, apixaban (Eliquis), dabigatran (Pradaxa) and rivaroxaban (Xarelto)?

Warfarin, apixaban (Eliquis), dabigatran (Pradaxa) and rivaroxaban (Xarelto) are a group of medicines that work by reducing the ability of blood to clot. They are also refered to as ‘anticoagulants’, and apixaban (Eliquis), dabigatran (Pradaxa) and rivaroxaban (Xarelto) may be referred to as ‘NOACs’ (an abbreviation of ‘non-vitamin K antagonist oral anticoagulants’).

You are at risk of developing blood clots if you:

  • have had hip or knee replacement surgery recently
  • are already at increased risk of having a stroke or getting a blood clot
  • have an existing blood clot in your lungs or legs.

You can be prescribed an anticoagulant to:

  • reduce the chance of blood clots forming in the brain, which may possibly lead to a stroke
  • treat or prevent blood clots in the lungs (pulmonary embolisom, or ‘PE’)
  • treat or prevent blood clots in deep veins, like those in the legs (deep vein thrombosis, or ‘DVT’). 

Living with anticoagulants

If you take warfarin, apixaban (Eliquis), dabigatran (Pradaxa) or rivaroxaban (Xarelto), it is important to use the medicine safely and correctly.

The benefits of these medicines need to be carefully balanced with possible side effects – not enough anticoagulation can lead to a blood clot or stroke, but too much anticoagulation can lead to uncontrolled or serious bleeding.

Follow these special steps to help reduce your risk of bleeding.

  • Take your medicine as your doctor has prescribed – know how much to take, when to take it, and what to do if you forget to take it or take too much.
  • Check with your doctor or pharmacist before you use any other medicines, including non-prescription and complementary medicines such as herbs and vitamins, that may cause interactions.
  • Tell all your healthcare providers, including your dentist, that you are taking an anticoagulant.
  • Tell your doctor if you have reduced liver function, liver disease or increased liver enzymes.
  • Be aware of the different signs of bleeding – such as bleeding gums, red or black bowel motions, easy bruising – so you can report them to your doctor.
  • Tell your doctor if you have characteristics which may increase bleeding risk, including being over 75 years old, reduced kidney function, dehydration, cancer, previous stomach or bowel ulcer, or a recent bleed, biopsy or serious injury.

Warfarin note – if you are taking warfarin, then you will have to follow slightly different steps to reduce your risk of bleeding with this anticoagulant. 

Find out more about warfarin and how to take it

Tests and monitoring

Before you start treatment for the first time, your doctor will do a complete blood test, check how fast your blood can clot under normal conditions, and assess your liver and kidney function.

While you are taking apixaban (Eliquis), dabigatran (Pradaxa) or rivaroxaban (Xarelto), it is important that you look out for signs of bleeding.

Your doctor will need to check your kidney function at least once every year, and re-check it if your health condition or medicine changes.

Warfarin note – unlike the NOACs, a routine blood test is used to monitor the anticoagulant effects of warfarin

Find out more about warfarin and how to take it

Taking a NOAC

Remember to take your medicine exactly as prescribed by your doctor. Taking it at the same times every day should help you remember when to take it.

How and when to take it

Unless advised differently by your doctor or pharmacist, swallow the recommended number of tablets whole with a full glass of water.

The dose, and how often you need to take it, can vary depending on a number of things, including:

  • which medicine you have been prescribed
  • what health condition you are taking it for
  • your age and body weight
  • your kidney function
  • your bleeding risk.

If you’re not sure of what to take and when, don’t be afraid to double check with a doctor, nurse or pharmacist. They can tell you if you have to take the medicine with food for it to work properly, or keep it in its packaging until you are ready to take it.

How long to take it for

Continue taking your medicine for as long as your doctor tells you. Do not stop taking it or change how you take it without checking with your doctor first.

Stopping can put you at increased risk of developing a blood clot, which may lead to a serious condition, such as a stroke.

What to do if you forget to take it

Keep a note of any missed doses and seek advice from a doctor, nurse or pharmacist – do not take a double dose to make up for the forgotten tablet.

What to do if you take too much

Get immediate emergency medical help if you have taken too much medicine – even if there is no discomfort or signs of poisoning. Taking too much may lead to serious bleeding that may not stop without emergency treatment.

Side effects of NOACs

Bleeding is probably the most serious side effect, but other side effects may include headache, nausea, diarrhoea or constipation, fever and coughing.

Symptoms such as shortness of breath, rash, itching and swelling of the face, lips or tongue may mean an allergic reaction and should be considered a medical emergency.

Signs and symptoms of bleeding

Signs and symptoms of bleeding can include:

  • bruising
  • bleeding gums
  • red or dark brown urine
  • red or black bowel motions
  • nosebleeds
  • coughing up blood or blood in your spit
  • trouble breathing or swallowing
  • heavier than usual menstrual period
  • bleeding from cuts, wounds and scrapes that takes longer to stop
  • dark or blood-stained vomit
  • severe headache or dizziness
  • unexplained pain, swelling or discomfort.

Some types of bleeding are more serious than others. If bleeding concerns you, is heavier than usual or takes an unusually long time to stop, you should speak to your health professional right away.

If you have questions about your medicine or need general information about side effects, you can call the NPS Medicines Line on 1300 633 424 (Monday to Friday, 9 am to 5 pm).

This is not a complete list of side effects. Occasionally people may experience other side effects. If you feel unwell while taking apixaban (Eliquis), dabigatran (Pradaxa) or rivaroxaban (Xarelto), even if you don’t think it’s related to your medicine, see your doctor or pharmacist.

More information

Fact sheets:

Phone services:

  • 1300 MEDICINES (1300 633 424) if you have questions about your medicines
  • 1800 022 222 for free immediate health advice from experienced nurses
  • 1800 787 653
  • 1300 362 787

4 min read