DoseStreaks
Health library
Using medicine safely

Blood thinners – living with warfarin or a newer one

They prevent strokes and clots, and they raise bleeding risk. What changes day to day, what to avoid, and the bleeding that needs a hospital.

Two different kinds

Anticoagulants are prescribed to prevent or treat clots — in an irregular heartbeat, after a deep vein thrombosis or pulmonary embolism, and with some heart valves. They do not thin blood in any literal sense; they slow clotting.

Used in South Africa:

  • Warfarin — Cipla-Warfarin, Marevan, Coumadin, Warfant

    Prevention and treatment of VTE; atrial fibrillation; mechanical heart valves

  • Rivaroxaban — Xarelto, iXarola, Austell Rivaroxaban

    Atrial fibrillation (stroke prevention); DVT/PE treatment and prevention; post-ACS

  • Apixaban — Eliquis, ZyQuis, Apixaban Accord

    Non-valvular atrial fibrillation (stroke prevention); DVT/PE treatment and prevention

  • Dabigatran — Pradaxa

    Non-valvular atrial fibrillation (stroke prevention); DVT/PE treatment and prevention; post-orthopaedic surgery thromboprophylaxis

  • Enoxaparin — Clexane

    DVT/PE treatment and prevention; ACS; thromboprophylaxis in medical and surgical patients

  • Warfarin needs regular INR blood tests, interacts with a great many medicines and with diet, and has a reversal agent readily available. It remains the required choice for mechanical heart valves.
  • The newer oral anticoagulants need no routine monitoring and have fewer dietary interactions, but they are less forgiving of missed doses because they leave the body faster.
  • Antiplatelet medicines such as aspirin and clopidogrel work differently and are not interchangeable with these.

Living with warfarin

  1. Take it at the same time every day, usually in the evening so a dose change after a test can be applied the same night.
  2. Keep vitamin K intake steady rather than avoiding greens entirely. It is a sudden change in how much you eat that destabilises the INR, not the vegetables themselves.
  3. Go for every INR test. This is not optional monitoring — the dose is set by it.
  4. Tell every prescriber and pharmacist that you are on warfarin, every time. Many antibiotics and painkillers shift the INR significantly.
  5. Keep alcohol steady and moderate; binge drinking destabilises it markedly.
  6. Carry a card saying you take it.

Living with the newer anticoagulants

  • Do not miss doses. Protection drops within a day, which is a bigger deal than with warfarin.
  • Ask what to do about a missed dose before it happens, because the answer differs by medicine.
  • Kidney function matters — doses depend on it and it is rechecked periodically.
  • Still tell every prescriber. They interact with less, not with nothing.
  • No routine blood test does not mean no follow-up; annual review is still needed.

Bleeding — what is expected and what is not

Bruising more easily, taking longer to stop bleeding from a small cut, and occasional nosebleeds or bleeding gums are expected. Apply firm pressure for ten minutes without peeking.

Tell any dentist, surgeon or anyone doing a procedure well in advance. Do not stop the medicine yourself to prepare for one — stopping without a plan causes strokes, and the decision belongs to the person who prescribed it.

Common questions

Can I play sport on a blood thinner?
Non-contact sport is generally fine and exercise is encouraged. Contact sports, and anything with a real risk of head injury or a hard fall, need discussing with your doctor.
Can I stop it once I feel fine?
No. These prevent something that would otherwise happen, so feeling well is the treatment working. Some courses are time-limited and some are lifelong — the prescriber decides, and stopping unilaterally is how strokes happen.
Do I need to avoid green vegetables on warfarin?
No — keep them consistent rather than avoiding them. A steady moderate intake is easy to dose around; wide swings are what destabilise the INR.

Sources

Last reviewed 4 August 2026.