What should I do if I forget my anticoagulant? - AF Association

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What should I do if I forget my anticoagulant?

BobD profile image
BobDVolunteer

This is a common question so i was delighted to come across the following in a new fact sheet from Thrombosis UK which I have been given permission to borrow. It has been approved by medical specialist so take it as gospel.

Apixaban.

Take the table as soon as you remember and take the following tablet at the usual time and then contiune as normal.

Dabigatran,

A forgotten does can be taken up to six hours PRIOR to the next dose due. Do not take double a dose to make up for any missed.

Edoxaban

Take the tablet as soon as you remember. Do not take more than one tablet in a single day to make up for any forgotten dose.Take the next tablet on the following day and then carry on as normal.

Rivaroxaban

If you are taking either 15mg or 20mg once a day and have forgotten a dose take it as soon as you remember. Do not take more than one tablet in a single day. Take the next tablet on the following day at your usual time and then carry on a normal.

So now you know!

Bob

58 Replies

Good sticky Bob 👍

Very useful - can it be pinned please?

BobD profile image
BobDVolunteer in reply to Finvola

Will email Rachel.

BobD profile image
BobDVolunteer in reply to Finvola

Now pinned post !

Thanks Bob.

Very helpful Thank you for sharing 👍

Great. Appreciate the answer.

Hi, with regards to Apixaban, does this mean that it can be taken within 3-4 hours of the next dose for instance or should it be left off that close?

BobD profile image
BobDVolunteer in reply to Eddie49

I just reported what was in the fact sheet so can't answer that questsion. If one is that forgetful maybe find a better way to remind one to take them at the proper time.

Eddie49 profile image
Eddie49 in reply to BobD

Sorry Bob, I have only just been put on Apixaban. I thought I had read somewhere that there is a six hour limit to the next dose even with Apixaban. Obviously, taking it on time is the way forward.

CDreamer profile image
CDreamer in reply to Eddie49

If I forget a dose I usually only remember when I go to take my next one! I certainly don’t take them within 6 hours.

Gilli54 profile image
Gilli54 in reply to Eddie49

I have reminders on my phone!! It really helps.

seasider18 profile image
seasider18 in reply to Gilli54

I once bought a second hand phone that had the previous owners reminder on it for a medication.

Nice . 👍. Meant to be

Me too. Becomes automatic .

Read individual

Fact sheet with your own blood thinner etc .

Question point •

If forget to take .

CDreamer profile image
CDreamer in reply to Eddie49

Exactly my thought.

Thank you Bob. So useful as I forgot or couldn't remember if I had taken my Apixaban, took another and then thought I had doubled up (old age). I dialled 111 and they just said go to A & E. I didn't because I had so much help on this site. Thank you again for making things absolutely clear.

Buffafly profile image
Buffafly in reply to Tapanac

I think I took an extra Apixaban a couple of days ago but it was too late by the time I realised and I'm still here. The Apixaban foil strip I have has 7 each side so I can easily see which day I am on but I have been distracted this week and concentration has gone to pot.

BobD profile image
BobDVolunteer in reply to Buffafly

Know the feeling!

GrannyE profile image
GrannyE in reply to Buffafly

I know the feeling too.

I asked my G P and Heamo Specialist .

Was told

It is again individual .

Severe AF Patients would Have specific instructions from Cardiology practitioner .

I as sticky blood pro clotter 3 years ago no heart issues , was told , just take the regular time the next day. Still in the bloodstream .

Individual Case and severity specific .

Qualified advise only .

I was advise this .

I am on apixaban. If I forget one I take one as soon as I remember and then work my way back to my normal time in hourly increments. So only ever have 11 hour intervals.

Ie. Should take it at 10am. Forgot until 1pm. Take tablet, take the next one at midnight, next one at 11am, next one 10pm and back to normal.

BobD profile image
BobDVolunteer in reply to lallym

From the above you will see that not really necessary.

lallym profile image
lallym in reply to BobD

Yes probably right but you know...safe/sorry!!

I think most people have a phone or a watch with an alarm on it -- or even the timer on your stove or something --- just set your device to go off at the same time every day as a reminder. Better to not have to even think about it -- just make it a normal part of your daily routine.

lallym profile image
lallym in reply to goldey

Do set timer and then get sidetracked!!

Buffafly profile image
Buffafly in reply to lallym

Me too!

Gilli54 profile image
Gilli54 in reply to lallym

Snooze button helpful for that one!!

BobD profile image
BobDVolunteer

For the record this advice is nothing to do with being in AF or not as it is medical advice from a different scource as stated. The amount of AF or even being in AF has no relevance here and as we know just having a diagnosis of AF brings on the risks which largely and for most people are not removed by any alledged "cure".

BobD profile image
BobDVolunteer

Best we agree to differ .

GrannyE profile image
GrannyE in reply to BobD

Am I right in thinking that after an ablation the blood vessels can be in fibrillation but the scar tissue stops the electrical impulses coming through to the atrium of the heart? The body can heal over the scar tissue and the A/Fib comes back to the heart itself

BobD profile image
BobDVolunteer in reply to GrannyE

That is a very simple explaination but in principle yes that is correct GrannyE. The scar tissue stops the rogue impulses from getting from one area to another but doesn't stop the base cause. All and any treatment is only for quality of life and suspension of symptoms. There is little really long term data but five years AF free has always been a target. Mine is now eleven years but other arrhythmias (not AF) arrived long before that.

Bloodredroses profile image
Bloodredroses in reply to BobD

Is this like a circuit breaker type treatment then?

My 80 year old Mother did well for AF on beta blockers . ?

What about Xarelto - if you forget to take it? I didn't see it listed.

BobD profile image
BobDVolunteer in reply to Tux18

Rivaroxaban! Xarelto is a trade name. I did not include any trade names only that of the drugs.

Tux18 profile image
Tux18 in reply to BobD

oh, I didn’t know.

BobD profile image
BobDVolunteer in reply to Tux18

Maybe I should go back and add trade names? If I can remember them lol 😁

Bloodredroses profile image
Bloodredroses in reply to BobD

I take Rivaroxaban 20 mg daily .

My reply above is what I was advised by G P and Heamo Clinic Specialist for ME SPECIFICALLY based on my individual condition severity .

The fact sheet for it says take the next time . As normal .

Maybe this is due to it still bring in the blood ? Which is reason to not panic .

I do not have AF , advise would be different .

Beyond own med fact sheet .

Ring your own clinic in relation with your own case notes .

My G P said when Rivaroxaban was new on market, she prefer I ask my Specialist via their P A at hospital Clinic .

Thanks for sharing and interesting to note .... Probably a strange question, but why wouldn't Warfarin be included?

BobD profile image
BobDVolunteer in reply to AFHenz

Valid question not strange.To be honest I'm guessing because Warfarin has such a wide window. If you don't take a dose for a whole day your INR would not suddenly drop to 1. From my experience it takes four or five days to do this. Similarly if you double dose nothing bad will happen. When I started my warfarin 15 years ago the system was to take 10mg for three days and then test and adjust accordingly . Now they try to creep up on target which can be frustrating as it often takes many weeks to find the right doseage. Remember that "our " target of 2.5 (i.e. between 2 and 3) is quite low compared to that for some conditions and up to 5 is not deemed dangerous by experts. I think that so long as your mg s over a few days average out it's all gravy as my boys would say.

Gilli54 profile image
Gilli54 in reply to BobD

Yep I think that’s right. I have my own machine now and can check it anytime. Especially useful if my diet changes. I send off my results by email and they email back my dose. Really easy to do and full training given by the wonderful staff in the anti coagulant clinic in the W QMC Nottingham. Once I realised stabbing your finger yourself is actually a piece of cake!!

Thanks for your observations on this Bob .... Makes my INR reading of 2.9 yesterday feel quite comfortable.

Thanks Bob, very helpful as I was wondering what to do having been three hours late taking my Rivaroxaban today. First time I ever missed a dose, don't know where my head was.

Bloodredroses profile image
Bloodredroses in reply to ijan

Ask your haematologist via their PA it depends on the severity of your individual condition . Self prescribing is not reliable . Med fact sheet is base level advise at best .

My APS Sticky blood I just take the next day I hours past .

For dental surgery I do not take for a day before .

My dentist . And oral hygienist has the Rivaroxaban notes on my notes .

I asked my Haematologist on a clinic visit or via their P A, specifically this before taking late dose or missing a dose .

Advise everybody does the same .

What about Warfarin Bob ? I know its a while since this post was on but I take Warfarin. So I am curious

RachelAdmin profile image
RachelAdmin in reply to benmaise

I have spoken with the original author of Bob's post, and the advice for warfarin is:

Take the dose as soon as you remember. The following day take the prescribed dose as normal.

Kind regards

Rachel - AF Association Patient Services

I have background AFib and take Apixaban. I was sooo stressed to begin with about missing it or taking two in error that I started using a seven day pill box. So I sort out the pills once a week. AND I set alarms on my phone for twice a day that reads APIXABAN. It has been a real help. My stress and anxiety really dropped.

That’s it 👍

It’s called C B T

Cognitive Brain Training

BobD profile image
BobDVolunteer

Used one for years.

I once by mistake took 2 Rivaroxaban 20mg. chemist advised that I would be ok but - if I cut myself/had a fall etc then would probably need to go to A&E to get any bleeding under control. Not made the same mistake since!

If it’s any consolation , whilst I was on the clot busting heparin self administered injections at home . One month .

I stood on an upturned UK (thick prong) plug spike . Bled like a ‘beetroot ‘. Middle of night , A & E was my last thing if didn’t stop . I googled , used. Ice , foot up then Vaseline , strangely . Less and less . Stopped 4/5 hours . If had been gushing whooshing from

A big cut , I would have gone straight . It was a hole in foot .

There are patches from chemist that have blood coagulants in them . Worth having a packet on hand . Not sure where they are now ??

What about if you cannot remember if you took it or not?

doodle68 profile image
doodle68 in reply to Jeans1234

Hi Jeans :-) I did that once and erred on the side of caution and waited until the next dose was due not wishing to overdose, after that I bought a little dosing box with days of the week marked on it to make sure it didn't happen again

Jeans1234 profile image
Jeans1234 in reply to doodle68

Thanks Doodle68, this happened to me the other night, and like you, I also erred on the side of caution. I will get myself a dosing box as you suggest, as I don't want this situation to happen again. Thanks very much for your suggestion.

BobD. am I right that you are like me on Warfarin or have I got wrong Bob ?

BobD profile image
BobDVolunteer in reply to George2467814

Correct have been for nearly16 years and see no point in changing. INR 85%+ in range,

I asked because I too have been on Warfarin for 8 years but now changes at surgery following COVID means they are discouraging visits so may be offered alternative anticoagulant...one of these more recent meds...what’s your view?

BobD profile image
BobDVolunteer in reply to George2467814

When I had my phone consult with my EP last month he mentioned that I might like to change but accepted when I declined. My local surgery is still doing INR checks with no issues.

Many thanks we see what the say to continuing as at present....

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