Prescribing the correct anticoagulant and maintaining the correct dose is essential to beneficial treatment and minimal risks. Each DOAC has a standard dose and a reduced dose. The criteria for dose reduction varies between products. Dose reductions depend on factors such as age, weight, renal function and concomitant medication. Selection of dose for any individual patient should reflect that in the manufacturer’s product licence. 

The combination of anticoagulation and antiplatelet therapy significantly increases bleeding risk. In many cases, the antiplatelet can be stopped when anticoagulation is introduced so this combination should always be clarified to ensure it is intentional. The most common scenario is where a patient has had a coronary intervention with a stent and where a period of combined therapy, dual antiplatelet plus anticoagulation followed by a period of single antiplatelet plus anticoagulation may be prescribed. 

Reflective exercise

Common questions patients may have about their anticoagulation medication include:

• Why does my blood need thinning if the problem is that my heartbeat is irregular? 
• Does it matter if I sometimes forget to take my anticoagulant – should I take double the amount the next day?
• What are the side effects?

Are you confident in answering these questions?