Counselling for DOACs

Counselling Check-list

Counselling Point


Reason for DOAC

Atrial Fibrillation – irregular heart beat = inefficient blood flow = clots = stroke/TIA

Mode of action

Anticoagulants thin the blood’ or reduce the ability of blood to form clots’



How to take

Apixaban: TWICE a day, with or without food – can be crushed
Dabigatran: TWICE a day, with or without food – DO NOT OPEN OR CHEW CAPSULES, DO NOT PUT IN DOSETTE BOX

Edoxaban: ONCE a day, with or without food – ADVISE NOT TO CRUSH (no data)

Rivaroxaban: ONCE a day WITH FOOD can be crushed


Importance of taking as prescribed – if a dose/day of medicine is missed, the

medicine will not work on that day putting the patient at risk of a stroke

Advise on adherence aids e.g. reminders.

Missed dose

ONCE-daily DOACs (rivaroxaban & edoxaban):

the dose should be taken immediately and then be continued the following day with the once-daily intake as recommended.
The patient should not take double th
prescribed dose on the same day to make up for a missed dose.


* resume 24 hour dosing from the new time of administration (if the patient wishes to return to their normal time of administration;
the time at which the dose is taken each day may be gradually adjusted by 1 hour/day) *[Verbal advice from manufacturer]


TWICE-daily DOACs:

Dabigatran – forgotten dose may still be taken up to 6 hours prior to the next scheduled dose.
From 6 hours prior to the next scheduled dose on, the missed dose should be omitted


Apixaban- If a dose is missed, the patient should take apixaban immediately and then continue with twice daily intake as before.

Informing healthcare


ESSENTIAL in an emergency situation, planning surgery, planning pregnancy,

dentist, pharmacist (interactions), practice nurse (immunisations)


Signs of bleeding and bruising (seek emergency help if severe) – epistaxis (if lasts

>10min seek medical assistance), haematuria, haemotypsis, haematemesis, melaena, abnormal genitourinary bleeding

See individual patient packs for drug specific side effects e.g. fainting with rivaroxaban (counsel on safety with driving/operating machinery)

How to manage a bleed

Apixaban, edoxaban, rivaroxaban – counsel on lack of specific antidote but that

general measures (e.g. PCC) have been used successfully

Dabigatran – direct reversal agent licensed


Periodically dependent on kidney or liver function


Check with pharmacist if buying OTC medication e.g. NSAIDs, aspirin not


Check with pharmacist regarding use of herbal medicines – avoid if possible

Food and alcohol

No known food interactions

No interaction with alcohol but staying within the recommended national guidelines is advised (3units/day for men and 2units/day for women)
(NB: risk of falls with excessive alcohol consumption)

Women of child bearing


Use reliable contraception whilst taking a DOAC

Discuss with doctor if planning pregnancy or as soon as possible if they discover they are pregnant

May experience heavier menstruation

Alert card

Carry alert card at ALL times