MUR SUPPORT FOR ANTI-COAGULANTS FROM
MUR QUESTIONS
MUR Question
All Anticoagulants
How are you getting on
with your medicines?



Warfarin Specific
NOAC Specific
An early opportunity for the patient to
highlight their issues
Also check if any herbal remedies such as
Ginseng, Ginko Biloba, St Johns Wort are
being used
Check if any OTC medicines such as
Ibuprofen or Aspirin are used
How do you take/use
each of your medicines?
Confirm what time of day the patient has
chosen to take their anti-coagulant
Ideally warfarin should be taken around
6pm to minimise variation in blood test
results
Are you having any
problems with your
medicines, or concerns
about taking them?

Many patients will worry about
bleeds/falls and the risks/benefits of anticoagulation
Be ready to listen and also offer the
benefits with regard to reduction in risk
of stroke
Explore how the patient is getting on with
regular monitoring – check that they are not
missing appointments because they “feel
well” or because they have been stable for
some time
Patients previously on or aware of warfarin
may worry about the lack of monitoring.
Reassure that blood tests are not required
because the effects are much more predictable
Do you think they are
working? (Is this
different from what you
were expecting)

A patient may not feel any different, or
have any way of knowing if the medicine
is working
Side-effects such as bruising may indicate
anti-coagulation effective to a patient
This may give an opportunity to discuss INR
and what the results mean
Patient may feel no different, and not know if
it is working


MUR SUPPORT FOR ANTI-COAGULANTS FROM
MUR Question
All Anticoagulants
Do you think you are
getting any side-effects
or unexpected effects?




Bruising more easily or bleeding for longer
from minor cuts is normal.
Seek medical attention of patient falls, or
is injured during treatment – especially if
they hit their head (due to increased risk
of bleeding)
Seek medical help if there is blood in urine
or tar coloured stools
Anti-coagulants do not cause unexplained
bleeds (e.g. nosebleeds) but will make
bleeding worse. The cause of the
bleeding should be resolved rather than
withdrawal of the anti-coagulant
It is important to take all anticoagulants
regularly at the same time each day
Because of the “6pm” rule for warfarin,
and the need to take Rivaroxaban with
food, 6pm is a good rule of thumb for all
anticoagulants unless a different time of
day would assist the patient to
remember
People often miss taking
doses of their medicine,
for a wide range of
reasons. Have you
missed any doses of
your new medicine, or
changed when you take
it (prompt: when did
you last miss a dose)?

Do you have anything
else you would like to
know about your new
medicine, or anything
you would like me to go
over again?
GP should be monitoring renal and liver
function annually

Warfarin Specific
NOAC Specific




It is recommended to take warfarin at
6pm each day – this minimises variation
in the results of blood tests
Never take a “double dose” the next day
to make up for a missed dose





A good opportunity to discuss alcohol
and interacting food/medicines
Interactions and changes to diet will
take around 5 days to change the result
of a blood test
Remember to complete a Yellow Card for
any adverse effects reported for these
relatively new medicines
Nausea is not uncommon – avoided in
Dabigitran by taking standing up with LARGE
glass of water (irritant if it gets stuck)
It is not important what time of day the
medicine is taken, so long as it is the same
time every day
A forgotten dose of Rivaroxaban should be
taken immediately it is remembered, but
should not be doubled up on the same day
to make up for a missed dose.
A forgotten dose of Dabigatran can be
taken any time up to 6 hours before the
next scheduled dose. If remembered later
than this, it should be omitted
If asked about monitoring – GP should be
monitoring renal function annually or more
frequently if clinical concerns