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This podcast has been developed by the Northern Health and Social Care Trust Pharmacy Department to help you understand more about medication that you or someone you know, have been prescribed.
Pharmacy Podcast - Managing your Medication Safely - Ep1 - Direct Oral Anticoagulants
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Hello, and welcome to this pharmacy podcast on managing your medication safely. This is one in a series of podcasts to help you understand more about medication that you or someone you know may be on. I'm your host, Joanne. I am a clinical education pharmacist based in Antrim Hospital, and joining me today for the podcast is Melissa.
She is also a clinical education pharmacist and is based in Causeway. Hi, Joanne, thanks so much for having me. It's great to be here today. Thanks, Melissa. Thanks for joining us. We do have a very important topic to discuss today. We are going to chat about a group of medicines called direct oral anticoagulants, and these include the medicines Apixaban, Edoxaban, Rivaroxaban and Dabigatran. There is another group of anticoagulants known as vitamin K antagonists, and that is usually warfarin. And we will discuss that in a different podcast. We hope that by the end of today's podcast, you should have all the information you need to ensure you take your anticoagulant safely or to support someone else to do so.
So let's get started, Melissa. What exactly is a direct oral anticoagulant? So a direct oral anticoagulant is a medicine that prevents harmful blood clots from forming in your blood vessels. And they do this by making your blood take longer to clot. So, is that a blood thinner then? So, some people call anticoagulants blood thinners, but the blood is actually not made any thinner, it just takes longer to clot whilst you're taking these anticoagulants.
And it does this by acting on very specific areas of the clotting system. So, do you need to have regular blood tests taken to check your clotting levels? So with direct oral anticoagulants, regular blood tests are not required to check how quickly your blood is clotting like we would see with people who take warfarin.
And this is because research and clinical trials have shown us how different doses of direct oral anticoagulants affect clotting in different groups of people. So we don't require blood tests to check for clotting, but do we need to have any other blood tests to check for anything else? You will have blood tests done before starting this medication and then at least once a year, for example to check how your kidneys and your liver are working, and also to check the red blood cell count.
And this tells us how we might need to adjust your dose to get the right amount of clot prevention. And your healthcare professional will advise you when your blood tests are due. Okay, thanks, Melissa. So let's discuss the different reasons why direct oral anticoagulants might be prescribed. So direct oral anticoagulants.
It can be used for many different reasons, um, and these include reducing the risk of getting a blood clot. For example, if you have a condition such as atrial fibrillation, or also known as AF, and this can increase your risk of having a stroke. They're also used to treat blood clots, um, as they're used to stop the blood clot getting larger or breaking off and traveling to other parts of the body.
For example, traveling to the leg, which is called a deep vein thrombosis, or traveling to the lungs, which is also known as a pulmonary embolism. Um, direct oral anticoagulants can also be used to prevent blood clots from forming following some types of surgery, but your healthcare professional will be able to explain to you the reason for you taking your anticoagulant.
Thanks, Melissa. So how long would a person normally be on this medication for? That's a good question. So, how long you need to take them for will depend on the reason that you are taking it. So, some people will need to take these anticoagulants for the rest of their lives and others may only need to take them for a few months.
If you are taking these anticoagulants long term, it is important to have an annual review with your healthcare professional to discuss the benefits and the risks. But, you should not stop taking these medicines without discussing it with your healthcare professional first. And how is the anticoagulant supplied?
A supply of the medication will be labelled with specific directions for administration and it will be supplied on discharge from the hospital. Further supply should be obtained from the GP just the same way that you would order all your other usual medication. Great. So it would be important then to make sure that you have enough supply of the medicine at home?
Yes, it's really important to make sure that you do not run out of these medicines and always have at least one week's supply at home. If you are going on holiday, it is really important to make sure that you have enough supplies of your medicines for the duration of your holiday. And another point to consider is that you should speak with your healthcare professional for advice if you're going to be traveling across time zones as well.
Oh, that's good to know. Um, so how do you actually know which dose to take? And another great question, Joanne. So as we mentioned at the start of the podcast, we're talking collectively about the four direct oral anticoagulants. So the dose will depend on which one you're prescribed and what you're taking it for.
But again, your healthcare professional will advise you on this and your medication will be labeled with the directions on how to take it. So because of the type of medication this is, it does seem to be very important not to miss a dose. Yes, it's really important to remember to take this medication as all direct oral anticoagulants do not stay or continue to work in your body for very long.
So missing a dose can increase the risk of a stroke or a clot developing, and this could be life threatening. So it is really important to take it every day as prescribed and try to take it at the same time every day. Do you have any advice then on what to do if someone does forget to take their medicine?
So if you do miss a dose, check the leaflet that is in your medicine box, but in general you should take the dose as soon as you remember and then take the next dose at the usual time and then continue taking your medication as before. Never take more than the prescribed number of tablets in one day.
And if you do accidentally take an extra dose, then it's really important that you contact your healthcare professional, as you could be at an increased risk of bleeding. So it could be helpful for people maybe to set an alarm or to use a calendar or have some way to remember to take their medicine.
Yes, exactly. All really good tips. However, if you are having trouble remembering to take your tablets, then make sure you speak to your healthcare professional about other aids that you can use to help you remember to take your medication. What if the reason for missing the dose is due to swallowing difficulties as opposed to forgetting to take your tablet?
So if you have difficulty swallowing your medication that you've been prescribed, it's important that you contact your healthcare professional for advice. It may be possible to crush Apixaban, Rivaroxaban and Edoxaban, and then mix with water or apple puree. But Dabigatran may need to be switched to an alternative anticoagulant.
As I've said before, do not change how you take your medication without speaking to your healthcare professional first. Is there any special diet that you need to follow while you're on a direct anticoagulant, like any particular foods or drinks that should be avoided? No, there's no special diets required or specific foods that need to be avoided, but I would advise eating a normal healthy diet.
And just to point out, as mentioned earlier in the podcast, this podcast is intended to provide information on the directoral, anticoagulants, Apixaban, Rivaroxaban, Edoxaban, and Dabigatran. So if you've been prescribed Rivaroxaban, it does work better if it's taken with food. Okay. So that's interesting. So just to be clear, it's the Rivaroxaban that is the one that's better to take with food.
Yes, exactly. Make sure to take Rivaroxaban with the main meal. So we've talked about food. What about alcohol? Do we need to avoid alcohol? So there's no interaction between direct oral anticoagulants and alcohol. However, if you do drink alcohol, we would encourage you to drink sensibly within the limits recommended by the Public Health Agency in Northern Ireland.
So, I do know that the government recommendations are that you should not regularly drink more than 14 units a week, and in that week you should have regular alcohol free days, and certainly, you know, avoid binge drinking and excesses. But it's quite confusing, what, what does one unit of alcohol mean? So, yes, so one pint of beer is equivalent to two units of alcohol.
One pub measure of a spirit is equivalent to one unit of alcohol, and a medium glass of wine is equivalent to two units of alcohol. But alcoholic drinks come in many different strengths and sizes, so the number of units is often marked on the bottle or can, so please remember it is dangerous to binge drink while on oral anticoagulants.
So we've discussed food and alcohol. What about other medications? Are there certain medicines that should be avoided when you're taking direct oral anticoagulants? Yes, there are medications that can increase the bleeding risk when taken with direct oral anticoagulants and should be avoided, including some medicines you can buy and herbal preparations.
So examples of these include ibuprofen or similar anti inflammatory painkillers, garlic supplements, Ginseng, Ginkgo, St. John's wort, and vitamin E. Aspirin should also be avoided unless advised otherwise by your doctor. So to be safe, it's probably good to inform your healthcare professional that you're taking a direct oral anticoagulant and to ask for advice before starting any new preparations.
And if you feel you needed to buy something for your health, inform your pharmacist and speak to them to check that it's okay. And it's important to remember as well, you can also find a patient alert card inside your medicine box. And this includes information that will be helpful to you and alert other healthcare professionals that you're taking an anticoagulant.
You should complete the appropriate sections and keep this card with you at all times as it may be important in an emergency to inform healthcare professionals before you receive other treatment. So that's really helpful to know about the alert card actually, and you can carry this with you. to tell, um, healthcare professionals that you're taking this medicine.
Um, for example, informing the pharmacist if you wanted to buy a medicine or other healthcare professionals. Um, for example, when you go to the dentist. Yes. And when you do visit the dentist, it's important to tell them that you're taking an anticoagulant medicine before receiving any treatment. In most cases, your dental treatment anticoagulant needing to be stopped.
And is that the same if you have surgery or a minor procedure? Yes. Okay. Um, so it's really important that you tell anyone who is treating you that you're on an anticoagulant. Um, so if you need surgery or a minor procedure, even attending the podiatrist, make sure that you tell your healthcare professional in advance that you're on this medication.
If you need to have an anesthetic for your procedure, you may need to stop taking your direct oral anticoagulant for a short time beforehand. But again, your healthcare professional will advise you if you need to stop. And when you should restart your medication. Okay, so what about the use of these medicines in pregnancy or breastfeeding?
So direct oral anticoagulants can seriously affect the development of a baby in early pregnancy. Women who are taking oral anticoagulants should discuss plans for future pregnancy with their doctors before trying to conceive, wherever possible, you should ensure effective contraception if appropriate. So what should you do if you think you might be pregnant?
You should take a pregnancy test as soon as possible, and if this is positive, you should make an urgent appointment with the doctor. And what about breastfeeding? Currently, there is no data relating to breastfeeding for any of these al anticoagulants. So at the moment, they're not recommended in breastfeeding.
So far, we've discussed lots of important aspects of these direct oral anticoagulants, but one thing we haven't discussed so far is side effects and when to seek medical attention. Can we talk a little bit about that now? Yeah, so all medicines do have the potential to cause side effects for some people.
You should read the patient information leaflet that comes with your medicine books. With anticoagulants, most side effects relate to bleeding, such as bleeding gums or cuts bleeding for longer. Um, you might also notice some bruising and swelling. Some patients will notice that they bruise more easily than before.
So if you cut yourself, make sure you apply firm pressure to the site for at least 5 minutes using a clean, dry dressing. Another common side effect is anemia, which is a low red blood cell count. And this may cause tiredness, dizziness, and paleness. So are there any times when you would need to seek medical attention?
Yes, if you experience any of the following, you should seek medical attention. So prolonged nosebleeds lasting more than 30 minutes, blood in your vomit, blood in sputum or phlegm, Passing blood in your urine or stools, passing black stools, severe bruising without injury or out of keeping with the extent of injury, unusual headaches, or any exceptional weakness, tiredness, dizziness, or severe headache.
For women, you should report any heavy or increased bleeding during your period or other vaginal bleeding. You should also seek medical attention if you're involved in a major trauma or suffer a significant blow to the head. Even if you're feeling well and there are no obvious signs of any injury, you should always get this checked out as a head injury could lead to serious internal bleeding.
If you're unable to stop any bleeding, it would also be really important to seek help immediately. That's great to know. What about any unusual side effects or allergic reactions? So, if you experience any unusual side effects or allergic reactions, which may include swelling of the face, lips, mouth, tongue, throat, or any difficulty breathing, you should seek medical attention immediately.
These may need to be reported through the Yellow Card Scheme. What is the Yellow Card Scheme? So the Yellow Card Scheme is a simple form that can be filled out online at www. mhra.gov.uk/yellowcard , to report side effects or reactions to medicines. And this allows them to be investigated and actions taken to help make medication safer for everyone.
And we've talked about side effects or that can happen because of the medicines. But are there any signs or symptoms to look out for that would alert you that the medicine isn't working quite as well as it should? Yes. So if the anticoagulant is not working as expected, then you may be at a risk of developing a clot and you should seek medical advice if you experience any of the following.
So a pain or swelling in your leg, and this can indicate a clot in the leg, any difficulty breathing, increased breathing rate, or chest pain. which could be symptoms of a clot in the lung, or any sudden inability to speak or slurred speech, as this could be a sign of a stroke. And remember to think FAST, so facial dripping, arm weakness, slurred speech, and then it's time to call 999.
So you've given us loads of really good advice in this podcast, is there any other relevant advice we should discuss? So people taking a direct oral anticoagulant can usually continue or start new physical activities. However, contact sport or dangerous activities should be avoided due to the bleeding risk.
It is important to think about any potential risks and then what you can do to prevent any risks of causing bleeding. So, for example, wearing gloves when you're gardening or using a soft toothbrush if you notice your gums are bleeding a wee bit more easily or using an electric razor. Um, I know there is a useful way that people can use their medicines safely called No Check Ask.
Yes, that's right. Um, so the No Check Ask campaign, so it's really important to know which medicines you're taking and what you take them for and it can also be really useful to keep an up to date list of your medicines. Check that you're using your medicines in the right way and ask your healthcare professional if you have any queries.
So No Check Ask. That's really good to know. Thank you. So, thank you so much, Melissa, for talking us through these medicines and for all your good advice today. Thanks, Joanne. Um, hopefully the listeners will have a better understanding of their direct oral anticoagulants after hearing this podcast. This podcast has given us loads of really good information.
Thank you. Remember that you can also find useful information regarding your new medicine in the information booklet supplied and the alert card. and the leaflet in your medicine box. And if you do have any other questions, please contact your healthcare professional and they'll be happy to advise you.
And remember, you can listen back to this podcast at any point if there's anything you would like to hear again. We would also appreciate if you could take a few minutes to give us feedback on this podcast. You will find the link in the podcast summary or on the Northern Trust website where you accessed it.
Thank you for listening.