Don’t Stop Taking Anticoagulants Without Talking to Your Doctor: NPS MEDICINEWISE

With anticoagulant medicine dabigatran (brand name Pradaxa) in the news this week following reports that safety information about the medicine had been withheld by the manufacturer, NPS MedicineWise is reminding people not to stop taking it without talking to their doctor.

Dabigatran (Pradaxa), apixaban (Eliquis) and rivaroxaban (Xarelto) are newer anticoagulant medicines that have been subsidised by the Pharmaceutical Benefits Scheme (PBS) since last year for preventing stroke in suitable people with atrial fibrillation — a medical condition where the heart beat is irregular.

While there are risks involved with these medications, NPS MedicineWise Design and Development Manager Ms Aine Heaney says that if you’re taking an oral anticoagulant it’s crucial that you don’t stop taking it suddenly without medical advice as this may put you at risk of blood clots that could cause a stroke.

“Talk to your doctor if you have any questions or concerns about oral anticoagulants because — like all medicines — there are risks as well as benefits involved in taking them. It is particularly important in the case of anticoagulants that people are alert to the signs of possible adverse events,” she says.

Warfarin has been the mainstay of anticoagulant therapy for many years and its anti-clotting effect can be monitored using a blood test (INR test). Unlike for warfarin, there are no equivalent tests to monitor the anti-clotting effect in people taking the newer anticoagulants to monitor how well these medicines are working, or whether there is too much anti-clotting which may lead to bleeding. 

While the main side effect of all anticoagulants is bleeding, unlike warfarin if you start bleeding while taking one of these newer anticoagulants, there is currently no way to reverse it quickly.

“Even though you won’t need to have INR blood tests if you have switched from warfarin to one of the newer anticoagulants, it’s just as important to have regular checks with your doctor to monitor your health, especially to detect any signs of increased risk of bleeding,” says Ms Heaney.

The newer anticoagulants are like any new drugs where the longer term side effects are still being understood.

“New medicines will always have emerging scientific evidence and it’s important this is available and accessible to regulators and health professionals in a timely way to ensure patient safety and optimal use of these therapies,” Ms Heaney said.

“Any new evidence that blood tests can assist us to use these newer anticoagulants more safely and effectively would be very welcome.”

Ms Heaney emphasises that anyone taking an anticoagulant should be aware of the signs of bleeding.

“Ask your health professional what signs and symptoms you need to look out for, when you should contact your doctor about them and when you need to go to a hospital emergency department. Some signs of bleeding may not be obvious, so it is important to know what these are,” he says.

“It is also a good idea to talk to your health professional about ways to reduce your risk of injury and chances of bleeding. Also, if you are hurt in a truck accident, then it is best to get help from injury attorneys. 

Remember that all medicines have risks and benefits and your health professional is best placed to support you in taking these safely and effectively.”

To help people find more information about the newer anticoagulant medicines and to make informed choices in conjunction with advice from their health professional, NPS MedicineWise has published information on its website at

For more information on prescription, over-the-counter and complementary medicines (herbal, ‘natural’, vitamins and minerals) from a health professional, call NPS Medicines Line on 1300 MEDICINE (1300 633 424) for the cost of a local call (calls from mobiles may cost more). Hours of operation are Monday–Friday 9am–5pm AEST (excluding public holidays).

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