This leaflet explains the anticoagulant medication you have been prescribed to help prevent deep vein thrombosis and pulmonary embolism after your Covid-19 illness, and how to use your medication safely. The anticoagulant you are receiving is called rivaroxaban (the brand name is Xarelto®). This leaflet does not contain all the information you need about your medicine, you should also read the manufacturer’s information leaflet provided.
Why do I need an anticoagulant?
The experience we have so far indicates that patients suffering with serious symptoms of Covid-19 are at increased risk of venous thrombosis. Venous thrombosis is where blood clots form in the veins and cause a blockage, and if the clots travel to other parts of the body this is called thromboembolism. These clots may form in the veins in the legs (known as a deep vein thrombosis or DVT), or they may settle in the small blood vessels in the lungs (called pulmonary embolism or PE). These conditions are serious and can be life-threatening.
Anticoagulant medicines, often referred to as ‘blood thinners’, can be used to help prevent this. We routinely use anticoagulants, to help prevent venous thrombosis during or after surgery or periods of illness or immobility. Although Covid-19 is a new illness, and we are still finding out more about its complications, what we know so far indicates that anticoagulants will be similarly beneficial.
Which anticoagulant medication will I receive?
While you are in hospital we will have been giving you tinzaparin injections under the skin once or twice daily. When you go home you will need to continue anticoagulant treatment for one further month. For most people this will be with rivaroxaban tablets. Your doctor, pharmacist or nurse will discuss the options with you and decide if rivaroxaban is suitable for you.
Rivaroxaban is intended for prevention of blood clots in other situations, so we are confident that it can be used safely for most Covid-19 patients. However the manufacturer does not market it for this purpose. Some of the information in the leaflet provided by the manufacturer may not be relevant to you, but you should still read it carefully as it contains important information that applies to everyone, including precautions, side effects and interactions with other medicines. There is also an alert card in the pack that you can carry in your wallet while you are on this medication to show to anyone treating you.
How do I take rivaroxaban?
The dose of rivaroxaban is one 10mg tablet once daily. Tablets should be taken with a drink of water, with or without food at the same time each day. You should take this for one month after being discharged from hospital, and then stop.
If you have difficulty swallowing tablets whole, rivaroxaban tablets may be crushed and mixed with water or apple puree just before you take it. If you need to have your medicines given via a feeding tube into the stomach, rivaroxaban tablets may be crushed and mixed with water, and given through the feeding tube.
How will I get a supply of rivaroxaban?
When you leave hospital we will give you a one month supply of rivaroxaban. This is all you need to complete the course; your GP does not need to continue the treatment. If you normally get your medicines supplied in a weekly box (e.g. dosette) we will liaise with your GP and community pharmacy to ensure you receive the intended course.
Are there any side effects?
Rivaroxaban can increase the risk of bruising and bleeding. If you notice any unexplained bruising or bleeding, you should contact your GP or NHS111 for advice; or if you have bleeding that doesn’t stop on its own, you should seek immediate medical attention.
Rivaroxaban may cause other side effects, which if they occur are usually mild; however some which occur less commonly may be serious. It is important that you read the manufacturer’s information leaflet that comes with your medicine, as it explains the side effects, how to spot them and what to do if you experience them.
What if I miss a dose?
If you forget a dose, take it as soon as you remember on the same day, and on the following day you should carry on taking one tablet once a day. Do not take more than one tablet in a single day to make up for a missed dose.
Can I take my other medicines while I am taking rivaroxaban?
There are some medicines that should be avoided or need extra care when used with rivaroxaban. Your doctor, pharmacist or nurse will check that it is safe to use with your other medicines and will advise if any changes need to be made. Make sure that they know about all of your other current and recent medicines, including over the counter and herbal/ alternative medicines.
While on rivaroxaban treatment you should avoid other medicines that thin the blood unless your doctor specifically advises you to take them. If you are normally on an anticoagulant or you take an antiplatelet drug (e.g. low dose aspirin or clopidogrel), make sure that your doctor is aware of this.
You should avoid taking anti-inflammatory painkillers (e.g. aspirin, ibuprofen or diclofenac) while you are on rivaroxaban, unless advised by your doctor. If you need to take medication for pain relief or fever, paracetamol is a suitable choice, but if you are unable to take paracetamol, talk to your doctor, pharmacist or nurse for advice.
What if rivaroxaban is not suitable for me?
Rivaroxaban will be suitable for most people, but for those who it is not, we may continue the tinzaparin injections you were receiving in hospital for one further month. Your doctor, pharmacist or nurse will discuss this with you.
Who can I ask if I have any questions?
If you have any questions or concerns about your anticoagulant medication, please ask your doctor, nurse or pharmacist.
- You can ask to speak to someone while you are in hospital, or if you have questions after you go home you can call the ward you were discharged from via the hospital switchboard (telephone 0191 482 0000) and ask for the nurse in charge on the ward that you were discharged from.
- Alternatively you can speak to our Pharmacy team (telephone 0191 482 0000 and ask for Pharmacy). The telephone numbers are also at the end of this leaflet.
Other things you can do to help prevent blood clots
It is important during your illness and recovery to drink plenty of fluids and to be as mobile as possible. When you are able, you should take regular walks, even if this is just around your home. If you aren’t able to move around on your own at home, talk to your doctor, nurse or physiotherapist as they may be able to suggest other ways that you can exercise. You should continue to observe the government’s up to date social distancing advice.
For further information
Queen Elizabeth Hospital Switchboard 0191 482 0000
Ask for the ward that you were discharged from.
Useful websites:
If you would like further information about health conditions and treatment options, you may wish to have a look at the NHS website at www.nhs.uk