Counselling a Patient on Apixaban

“Before I explain the medication, can I check what you’ve already been told about apixaban?”

“Is there anything in particular you’re worried about?”

“Apixaban is an anticoagulant, which people often call a blood thinner. It does not literally thin your blood, but it makes it less likely to form harmful clots.”

“The reason we are recommending it is because of your atrial fibrillation. In AF, the top chambers of the heart do not squeeze as regularly as they should. Blood can sometimes collect there and form a clot. If a clot travels to the brain, it can cause a stroke. Apixaban reduces the chance of that happening.”

“You take it twice a day, usually once in the morning and once in the evening. Try to take it at roughly the same times each day.”
“You swallow the tablet with water, and you can take it with or without food.”

“If you forget a dose, take it as soon as you remember and then take the next dose at the usual time. Do not take a double dose to make up for it. If you are unsure, check with a pharmacist or doctor.”

“For AF, apixaban is often a long-term medication because it continues to reduce your risk of stroke. We will review it regularly, but you should not stop taking it without speaking to a doctor.”

“The main side effect is bleeding. You may bruise more easily, have nosebleeds or bleeding gums, or find that cuts take longer to stop bleeding.”

“You should seek urgent medical advice if you notice blood in your urine, black stools, vomit or cough up blood, have very heavy bleeding or have bleeding that will not stop.”

“If you develop a sudden severe headache, confusion, weakness, difficulty speaking or collapse, you should also seek urgent help.”
“If you hit your head while taking apixaban, you should seek urgent medical advice even if you feel well at first.”

“I appreciate that bleeding can sound worrying. We recommend apixaban because the benefit of reducing your risk of a serious clot or stroke is expected to be greater than the additional bleeding risk.”

“Unlike warfarin, apixaban does not usually require regular blood tests to measure how thin your blood is. We will still check your blood count, kidney function and liver function from time to time to make sure the medication remains safe for you.”

“It is important to tell any doctor, dentist or pharmacist that you take apixaban, particularly before a procedure or before starting a new medicine.”

“Please check before taking anti-inflammatory painkillers such as ibuprofen or naproxen, because these can increase the risk of bleeding.”

“You do not need a special diet, but avoid excessive alcohol because it can increase bleeding and the risk of falls.”

“You should carry your anticoagulant alert card and show it to healthcare professionals when needed.”

“So, to summarise, apixaban reduces your risk of harmful clots and stroke. You take it twice daily and should not stop it without medical advice. The main risk is bleeding, and you should seek urgent help for serious bleeding, concerning neurological symptoms or any head injury.”

“Does that explanation make sense? Is there anything you would like me to go over again?”