Gums bleeding with Rivaroxaban


I'm back to ask for your advice again! When my gums started bleeding my GP sent me to my dentist. Neither could agree what caused the problem, but then it stopped and I stopped worrying. On Friday afternoon it started again - it had never happened during the day before - and now blood is still seeping from around the gums on the top left hand side of my mouth.

My problem is I have at long last booked my holiday to SA and Botswana and I'll be away for 11 weeks, leaving on Wednesday! I've tried ringing the anticoagulation clinic at Oxford where I had my ablation in January, but they don't appear to be open on Saturdays. I take 20mg of Rivaroxaban daily and after looking at several websites I see that bleeding gums is a common side effect. I don't know what to do. I'm leaving in 4 days so it is too late to try an alternative anticoagulant, which may have worse side effects.

As it is a gradual seepage can I just ignore it (I'm in no pain)? Is it possible it could get a lot worse? Would halving the dosage help - and still protect me from strokes? I have a glass of wine with dinner - should I cut that out?

I don't know who to ask and am panicking about my trip. In Botswana in the bush there'll be no medical help. Does anyone have a number of an anticoagulant clinic which could reassure me today - the idea of waiting until Monday for doctors and dentists to open is not good.

Thanks so much for reading this.


30 Replies

  • Sue go and enjoy that holiday. My gums have been bleeding for years thanks to poor dental hygiene in the past which my dentist blames on NHS who never do proper hygiene. I'm on warfarin by the way. DO NOT put your self at risk by stopping or reducing the dose of rivaroxaban. Keep brushing properly, use interdental brushes and an antiseptic mouthwash or better still brush with Corsodyl gel after normal cleaning. (Ten minute regime).

    Since my dentist told me that if your gums bleed then it is always a gum disease problem I suspect that it is merely the anitcoagaulation exacerbating your previously unknown problem. Whatever you do worry will not help and eleven weeks is no time at all in a lifetime.



  • Bob, thank you so much, I was so worried it could lead to something worse. I have Corsodyl Daily, but I'll get the gel and use that too.

    My husband says thanks too, he was wondering if we would have to delay the trip again!

    I, like everyone else on this site, really appreciate your input.


  • Sue, if you get the gel, my dentist advised me to use floss tape to push the gel up into the pocket around the tooth (I have gum problems).

    In our Tesco, they keep the gel behind the pharmacy counter rather than on the shelf.


  • Thanks, Caroline.

    I have just bought the gel from Boots and as you say, I had to ask for it because it was behind the counter. (I wonder why?)

    I'll take your advice about the floss tape.


  • I had a back tooth pulled on Friday. I was given mouth wash and antibiotics. As it is i take pradaxa that was why my dentist didn't want to chance it and she sent me to the hospital. I'm dying for a cuppa but told nothing hot until pain subsides.

  • I was originally put on 20mg of Rivaroxaban and my gums tongue and roof of my mouth bled so badly I used to wake up in the morning looking like I was a vampire. I went to see my GP and she saw the blood on the roof of my mouth and reduced the dose to 15mg. After about three days the bad bleeding stopped. I do still get some gum bleeding but nothing like it was before. My GP said that the dose is the same for a 20 stone man or a 10 stone man so it is difficult to predict when first starting taking it whether the dose is too high or not. I suggest you go back to your GP.

  • Thanks. That sounds much worse than mine. Did your GP assure you that you would get adequate stroke cover with 15mg? As I said, my GP said it couldn't be changed and referred me to my dentist.

  • Hi. My GP referred me to a Consultant at the Maxillo clinic at the Hospital as I do not have any tooth problems or gum disease but had white patches on gums. I had two biopsies and were negative but was diagnosed with burning mouth and tongue syndrome which was made worse by the Riveraxban. I have to use Difflam mouthwash now even though I have been given a lower dose. Both my Consultant and GP agreed that even with a lower dose the chances of getting a stroke was much less than when I was on aspirin. I could have put up with the gum bleeding if it was only temporary but have to remember taking the anticoagulant is for the rest of your life.

  • Thanks, I'll bear that in mind if things don't improve, but with all the advice I'm getting I am feeling positive at the moment!

  • Glad to hear that.

  • Patient007 doses of meds are not affected merely by your body weight. They are affected by the genetic tendencies of something called your P450 detox system. For ex. I am taking warfarin: the starting dose is usually 5 mg per day and you go up from there slowly. I had to start on 1 mg. and work up to 2.5 because the detox pathways used by warfarin to leave the body, are underfunctioning in me. I evntually went up just a tad because I included a lot of greens and veggie in my dailey diet , but a consistent amount every day. In my first expereince with warfarin, I showed my cardiologist all of my genetic polymorphism tests involving the detox and other things and asked her to consider her prescribing dose be guided by my genetic tests. she looked over the tests, nodded as though she were thinking about them and actually knew what she pretended to read and prescribed 5 mg. to start , which at the time I did not know was the wrong course of action. After 3 days when I woke up in the morning my bed looked like a crime scene investigation from a tv show. I called her and she said STOP TAKINg IT!!--I had already ratcheted down to 2.5, then 1 as the bleeding only stopped entirely at 1 mg. It is not good for patients to decide their own amounts of things like this but in this case it was lief saving.The doctor is in NYC, I am 300 miles away upstate. I thought I was going to an expert cardiologist. She should have referred me to a coumadin lab near my home. At the time I saw her I did not know this or thqat there was such a thing as a coumadin lab. I "fired " that doctor because listening to her would have killed me. The lab is 1 mile from my home. The nurse there does one thing. Measures INR and prescribes dose of warfarin--she is very expert at what she does. YOU SHOULD BE ABLE TO HAVE IMMEDIATE ACCESS TO SOMEONE WHO MONITORS YOUR ANTICOAGULANT MEDS EVEN IF IT IS NOT COUMADIN, BECAUSE YOU ARE TAKING SOMETHING DANGEROUS TO KEPP YOU FROM DYING FROM SOMETHIHNG DANGEROUS, HOWEVER PARADOXICAL THAT SOUNDS.

  • There are no INR sfor Rivaraxoban as it is a new drug they use now as an anticoagulant. They very rarely prescribe Warfarin now. The usual start dose for Rivaraxoban is 20mg.

  • meant no INR tests for Rivaraxoban like Warfarin.

  • I've just returned from Botswana today and am also on Rivaroxaban. I don't suffer from the kind of bleeding you describe, having made a deliberate decision to improve my dental health earlier this year.

    I've also been to SA. A fabulous holiday awaits you. This most recent trip was with a group of people aged 50 to 80+. Between us we must have had many ailments. (Is it just me that finds overt pill-taking at meal times strange?). We certainly didn't sit around talking about out health. Be glad that you don't have to manage the added complication of Warfarin. Enjoy!

  • Glad you enjoyed your trip. I used to live in SA so know it is going to be wonderful. As the bleeding gums has only happened with Rivaroxaban the GP suggested I change back to Warfarin, but as you say - that would have caused its own problems with INR checks.

    Do you mind if I ask how you improved your dental health? I brush thoroughly, use floss and Corsodyl Daily. Bob suggested Corsodyl Gel, which I will try. Do you have any other suggestions?

    I'd love to ask about your holiday, but I guess this is not the correct forum!

    Thanks for your reply.


  • PM would cover that, copy to me please 😀

  • Hadn't been to the dentist for a very long time! Knew all the reasons why I should, but responded to a mild telling off from the cardiologist. Another appointment next week with the hygienist. I expected to be told to use Corsodyl but she prefers me to use inter-dental brushes.

  • Thanks - they're on my list!

  • You could always try one of the other NOACs.

  • I did think of that, but as I am leaving for Africa in two days I thought it better to leave changes until I get back if things haven't improved - but with all the good advice I am getting I'm hoping to have fewer problems!



  • @Mrspat , my daughter and I are hoping to make a trip to SA one day, and would love to hear how yours was arranged as last time I went to stay with family and they were so concerned for our safety they practically kept us prisoner! I was concerned about insurance but you must have had the same problem?

  • Hi. I am also on 20 mg of Rivaroxaban an had problem with bleeding gums. I am now using Listerine Advanced Defence mouthwash. It says it is gum treatment for gingvitis which is one reason for gum bleeding. I am using for about a month and have little or no gum bleeding now so it appears to be working. I picked mine up in Boots so widely available. Enjoy your trip

  • Thanks, that sounds good.

  • Dip your interdental brushes or picks in the corsodyl and use twice daily. Should have a reduction of bleeding and inflammation. Also use if any food gets stuck between your teeth. I'm a Dental Hygienist in the US.

  • Thank you for this good suggestion. I'm overwhelmed with all the positive responses. Hope other readers are benefiting too!

  • @hydrangea bleeding gums ( not counting that you take an anticoagulant) are usually caused by a Vitamin C with the citrus biflavinoids deficiency especially rutin- in other words it is like subclinical scurvey. I f I do not take 4000- 6000 mg of this vitamin with flavinoids after a while I start to get a sore throat and also gums bleeding etc. this also causes rough skin. It is a vitamin C deficiency , Don't you have a clinic nurse who specifically monitors anticoagulant side effects and dosage?

  • Hi traveler65

    That's an interesting new idea. I eat lots of fruit, including oranges, so I've never thought I could be deficient in vitamin C. It won't hurt to have extra, so I'll add that to my list of 'must do'.

    No I don't go to an anticoagulant clinic. When I had my ablation in January my EP announced me 'cured' and I haven't seen a specialist since that last three month check-up. I feel fine, except for the gums - so I really can't complain!


  • @HYDRANGEA CONSIDERING WHAT YOUR HEART WENT THROUGH DURING AFIB AND ABLATION , YOU ARE USING UP VITAMIN c GANGBUSTERS--SO YOU PROBABLY NEED MORE THAN YOU REALIZE. If you use a supplement make sure it contains the flavonoid Rutin. You are actually using up huge amounts of vit C., all the B's and trace mins, and Co Q 10. If you take any B's reduced bioavailable ones are the best Ex. B-right by Jarrow ( $8)- contains quadrafolate form of folic acid, methylated B12, and P5P form of B6.To get the other vit's aand mins and antioxidant An eye pprotection supplement supplies the rest: A,E, trace mins, lutein, zeaxanthin,glutathione, N acetyl cysteinies a good one might be "Ocuguard plus" type of supplement-alsoi look at Mk4 and Mk7. In the event you do any of this stuff amke sure you research whether or not it will harm you byinteracting adversely with anything.

  • Wow, that's impressive! I've never heard of half of those, I'll have to start reading labels.

    I had heart failure in July 2015 resulting in a cardioversion. At that point my meds were changed from warfarin to rivaroxaban (not at my request). I had the ablation this January and since then I have not had any tests done. I'll check that out when I get back from Africa at the end of November - leaving in 2 days - can't wait!

    Thanks for your help.


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