What You Need to Know About Blood Thinners

Published: March 02, 2021
By Jenna Forry, PharmD

Blood thinners, also known as anticoagulants, are prescribed to reduce your risk of stroke and to help stop blood clots from forming in your body.

Why are blood thinners used?
You may need a blood thinner if you have experienced a clot in one of your veins, your arteries, or your lungs. Blood thinners may also be used in people who have a type of irregular heartbeat called atrial fibrillation. These conditions can put you at an increased risk for stroke, clot complication, or death.

What are the differences between blood thinners?
Several types of blood thinners are available on the market today. Warfarin (Coumadin, Jantoven) was approved by the Food and Drug Administration (FDA) more than 60 years ago. The FDA has since approved five additional blood-thinning agents called direct oral anticoagulants (DOACs):

  • dabigatran (Pradaxa)
  • rivaroxaban (Xarelto)
  • apixaban (Eliquis)
  • edoxaban (Savaysa)
  • betrixaban (Bevyxxa)

How does your provider care team decide which blood thinner is best for you?
Your care team includes you. Shared decision-making is when you and your healthcare team members work together to make decisions about your treatment while respecting your values and preferences. Shared medical decision-making involves letting you know about different treatment options. Based on this information, you can weigh the different options and talk with your care team to make the best medication choice for your lifestyle.

The following table includes specific information about available blood thinners.


How to take

Warfarin is taken once daily but may have frequent dose changes, especially at the beginning of your treatment.

Apixaban or dabigatran are taken two times a day.

Rivaroxaban, edoxaban, and betrixaban are taken once a day.


Warfarin requires weekly or monthly blood tests to check the medication levels in your blood.

DOACs have no specific monitoring recommendations, but they may require an adjustment if you have kidney problems.


Foods high in vitamin K, like dark green leafy vegetables, may make warfarin less effective. Alcohol may alter the effectiveness.

Rivaroxaban is more effective if you take it with food.


All blood thinners may increase your risk of bleeding, although apixaban may have less bleeding risk than warfarin. There are medications available to reverse the bleeding risk.

Medication interactions

Unless directed by your doctor, do not take blood thinners with aspirin or NSAIDs (like ibuprofen or naproxen) because they may increase your risk of bleeding.

Warfarin may interact with antibiotics or certain dietary supplements such as coenzyme Q10, echinacea, garlic, ginkgo biloba, ginseng, goldenseal, or St. John’s wort.

What do you do if you have any bleeding?
Blood thinners interfere with the formation of blood clots, and your body may not be able to stop bleeding if you have an injury. Contact your doctor if you have any bruises that continue to get bigger, nosebleeds, or cuts and scrapes that do not stop bleeding. Go to the emergency room if you are coughing up blood, have any blood in your urine or stool, have fallen and/or hit your head, or have any shortness of breath or chest pain.

Are blood thinners expensive?
The cost depends on your prescription drug insurance plan. While warfarin tends to be cheaper than the newer agents, increased monitoring expenses may offset the lower medication cost.

What are some important tips to remember about blood thinners?

  • Always take your blood thinner as instructed by your pharmacist or healthcare provider. To get the best results from your medication, you must take it regularly and at the same time each day.
  • Consult your pharmacist if any of your medications change, if you are prescribed any new medications, or if you are considering taking an over-the-counter medication or dietary supplement.
  • Ask your pharmacist or doctor if you have any questions about your blood thinner or the options available to you.

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