What if you have anticoagulant-related bleeding?

If you have been diagnosed with atrial fibrillation - also known as AF or AFib - your doctor (a GP or a cardiologist) may prescribe you an anticoagulant, often called a blood thinner, to reduce your risk of stroke caused by AF.1,2

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If you are on anticoagulants, you may bleed more easily

Anticoagulants are used to slow down the formation of blood clots that cause strokes. They can also make it harder for new blood clots to form. This may help reduce your risk of a stroke.1 However, this also means that you may bleed more easily- especially if you fall or hurt yourself - and any bleeding, if it happens, may take longer to stop.1,3
For example, if you bump into something, your bruising may be more severe than before you took an anticoagulant.3
If you are bothered by the look of bruising, you are not alone – lots of people on anticoagulants worry about bruising, so sharing experiences can help.

Bleeding can occur in different parts of your body

You may notice more bleeding than usual in your:3,4

  • Nose
  • Gums
  • Urine - as bright pink, red or dark brown blood5
  • Stools - as bright red, dark brown, or tarry black stools6
  • Vomit - as bright red or dark brown vomit, looking like coffee grounds7
  • Cough
  • Heavier menstrual periods, if you are a woman

You should tell your doctor about any bleeding that you may have.3
If you, or those around you, notice any dark brown blood in your urine or vomit, or a black, tarry stool – please seek medical help immediately.6 Your healthcare team will know what to do.

You may also bleed more easily within your body, especially after an injury or during a surgery. Internal bleeding may occur in different areas of your body6 and it can be particularly dangerous if it occurs in the brain, as this may cause another type of stroke called haemorrhagic stroke. However, bleeding in the brain is typically rare.1

Symptoms of internal bleeding depend on where the bleeding is coming from. If you have bleeding in your head you may feel weakness or numbness, usually on one side of your body, tingling, especially in your hands and feet, a severe, sudden headache, or loss of balance and coordination, among others. However, if you notice any dark blood in your urine or vomit, or a dark, tarry stool, this may be a sign of internal bleeding in your chest or abdomen. Likewise, an unexpected pain or swelling may be caused by Internal bleeding in your muscles or joints.6

You should ask your doctor about the symptoms of internal bleeding and seek medical help immediately if you have any these symptoms. Your healthcare team will know what is the most appropriate treatment for you. Although bleeding can be worrying, you can rest assured that it is one of the things your doctor will be keeping a specific eye on.1,6

Watch a short animation on what if you have anticoagulant-related bleeding

You can take a few steps to minimise your risk of bleeding when on an anticoagulant

Knowing what you can do to minimise bleeds will help you feel more prepared. These are some of steps that you can take:

  • Be extra careful or use a knuckle shield when preparing food
  • Use an anti-slip bath mat
  • Use a softer toothbrush to protect gums
  • Always wear gloves when gardening or doing other activities where you can get hurt, such as making repairs at home

When you first start taking an anticoagulant you may receive a pack from your doctor or clinic with an anticoagulation alert card. Remember to carry the anticoagulation alert card wherever you go, including when you are travelling. This is very important! If you are ever in an emergency situation, your alert card will tell the person treating you that you are on an anticoagulant. They will know what to do when treating you.1,4

  • Make sure you always tell everyone in your healthcare team – including your doctor, dentist, and nurse prior to having any procedure done, or pharmacist when having prescriptions filled – that you are taking an anticoagulant1,3
  • Before you take any other medications - including prescription medicines, over-the-counter medications, and herbal supplements - always ask your doctor or pharmacist if there are any interactions between your anticoagulant and those medications1,3
  • Aspirin may make you more likely to bleed when taken while you are on an anticoagulant1 – you should always let your healthcare team know if you are taking aspirin for any other medical reason, such as a previous heart attack, or even if you take it occasionally for headaches or fever1
  • If you are on a commonly prescribed anticoagulant called warfarin your dentist should check your recent INR result before carrying out any dental treatment to decide whether or not you should stop taking warfarin beforehand1
  • If you are on other type of anticoagulant your doctor may instruct you to stop your medication for up to 48 hours before your dental treatment and start your anticoagulant again, as appropriate after your dental treatment8
  • If you are on warfarin and have a planned surgery, your doctor may instruct you to stop taking your anticoagulant 5 days before your surgery and start taking it again immediately after your surgery9
  • If you are on other type of anticoagulant, your doctor may instruct you to stop your medication for up to 48 hours before your surgery and start taking your anticoagulant again immediately after your surgery8

Eating a healthy, well-balanced diet is great for you, as it may reduce your risk of stroke due to AF. If you are being prescribed an anticoagulant, make sure you speak to your healthcare provider to understand any dietary modifications you may need to make.1,4

Alcohol increases your risk of having a serious bleed. Therefore, you should always keep your consumption of alcohol to a minimum while on an anticoagulant.1

If you cannot get bleeding to stop, or if you are worried that something is wrong, please contact your doctor straight away.1

1. Stroke Association. Atrial fibrillation (AF) and stroke. May 2019. Available at https://www.stroke.org.uk/sites/default/files/media-root/f26_atrial_fibrillation_and_stroke_v4_web.pdf. Last accessed November 2020.

2. NHS. Atrial fibrillation, treatment. Available at https://www.nhs.uk/conditions/atrial-fibrillation/treatment/. Last accessed May 2021.

3. NHS. Side effects. Anticoagulant medicines. May 2018. Available at https://www.nhs.uk/conditions/anticoagulants/side-effects/. Last accessed November 2020.

4. NHS. Warfarin. April 2019. Available at https://www.nhs.uk/medicines/warfarin/. Last accessed November 2020.

5. NHS. Blood in urine. Available at https://www.nhs.uk/conditions/blood-in-urine/. Last accessed November 2020.

6. Healthline. Internal Bleeding: Causes, Treatments, and More. Available at https://www.healthline.com/health/internal-bleeding. Last accessed November 2020.

7. NHS. Vomiting blood (haematemesis). Available at https://www.nhs.uk/conditions/vomiting-blood/. Last accessed November 2020.

8. Steffel J et al. Europace 2021;00:1-65.

9. Oxford University Hospitals NHS Foundation Trust. MIL Volume 10, No. 5. Available at https://www.ouh.nhs.uk/services/referrals/specialist-medicine/documents/mil-v10-n5.pdf. Last accessed May 2021.

PP-ELI-HKG-0653 JUN 2021