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| A Cardiologist’s Perspective |

Missing A Dose of Blood Thinners: Potential Side Effects and Management

February 2025

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Blood thinners, or anticoagulants, are medications designed to prevent the formation of blood clots. Blood clots occurring in the body can lead to serious medical conditions such as deep vein thrombosis (DVT), pulmonary embolism (PE), stroke, and heart attacks. Where prescribed, these medications are crucial for patients with certain conditions. Therefore, missing a dose can have significant implications. 

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In this segment, Col. (R) Dr. Mohamad Anuar bin Mohamad, Putra Medical Centre Alor Setar’s resident consultant physician and interventional cardiologist, tackles the potential harms of missing a dose of blood thinners and how patients can safely manage their medication schedules for the best outcomes.

Col. (R) Dr. Mohamad Anuar bin Mohamad, Interventional Cardiologist at Putra Medical Centre

Watch video here:

POTENTIAL SIDE EFFECTS OF MISSING A DOSE

1.   Increased risk of thromboembolism

The main concern behind missing a blood thinner dose is the increased risk of thromboembolic events. When the medication is not taken as prescribed, the levels of anticoagulant in the bloodstream can become subtherapeutic, meaning they aren’t sufficient to prevent clot formation. This could result in:

Deep vein thrombosis (DVT): A clot that forms in the deep veins, typically in the legs. Symptoms may include swelling, pain, and tenderness.

Pulmonary Embolism (PE): A serious condition where a clot dislodges and travels to the lungs, which can cause symptoms such as sudden shortness of breath, chest pain, or even collapse.

Stroke: In patients with conditions such as atrial fibrillation, missing doses can lead to an increased risk of stroke due to the formation of clots in the heart that may travel to the brain.

Myocardial Infarction: Similar to strokes, there is a risk of a heart attack due to clot formation in the coronary arteries.

2.   Variability in patient response

Individual responses to anticoagulants can vary widely based on numerous factors, including age, weight, renal function, and the presence of other medical conditions. Missing a dose can disrupt this delicate balance, leading to unexpected increases in clotting risk.

MANAGING MISSED DOSES SAFELY

When a patient realises a dose of his or her blood thinner has been missed, these steps must be taken:

Immediate action: If the missed dose is remembered within a few hours, it should be taken as soon as possible. If it close to the time for the next scheduled dose, the missed dose should be skipped and the regular dosing schedule resumed. One should never double the dose to make up for a missed one.

Consultation: In the case of warfarin, patients should closely monitor their international normalised ratio (INR) levels following a missed dose, and consult their healthcare provider for guidance regarding any necessary adjustments.

Patient education: It is vital for patients to be educated about the importance of adherence to their anticoagulant regimen. Setting reminders, using pill organisers, or employing mobile applications can help improve compliance.

Monitoring for Symptoms: Patients must be vigilant regarding symptoms indicative of blood clot formation like swelling in the legs or chest pain, and seek immediate medical attention if these occur.

FREQUENTLY ASKED QUESTIONS (FAQ)

1.   What should I do if I miss a dose of my blood thinner?

Take the missed dose as soon as possible if remembered within a few hours. If it’s close to the next dose, skip it and resume your regular schedule.

2.   What are the risks of missing a dose of blood thinner?

Increased risk of thromboembolism, leading to complications like DVT, PE, stroke, or a heart attack.

3.   How can I remember to take my blood thinner on time?

Use alarms, pill organisers, or integrate medication reminders into your daily routine.

4.   Is it safe to skip a dose occasionally?

While occasional missed doses may not have immediate effects, consistent adherence is crucial to reduce the risk of complications.

5.   What should I do if I accidentally take two doses at once?

Contact your healthcare provider immediately for guidance, as this may increase the risk of bleeding.

6.   How does warfarin differ from newer anticoagulants regarding missed doses?

Warfarin requires regular INR monitoring; newer anticoagulants typically do not require routine monitoring but still follow similar management principles.

7.   Are there any specific dietary considerations when taking blood thinners?

Yes, especially with warfarin, where consistent vitamin K intake is essential to maintain stable INR levels.

8.   What symptoms should prompt me to seek medical attention after missing a dose?

Seek immediate medical attention if you experience symptoms of a blood clot, such as leg swelling or chest pain.

9.   Can I stop taking my blood thinner if I feel fine?

No, don’t stop without consulting your healthcare provider; this can increase the risk of clot formation.

10.   How often should I have check-ups if I’m on blood thinners?

Follow-up frequency varies; patients on warfarin typically require more frequent INR monitoring, while those on newer anticoagulants may need less stringent follow-ups.

TAKING CARE WITH ANTICOAGULANTS

Missing even a dose of blood thinners can have serious consequences, including an increased risk of thromboembolic events. It is essential for patients to understand the importance of adherence to their medication regimen and know how to manage missed doses safely. By being proactive and well informed, patients minimise their risk and maintain optimal health while on anticoagulation therapy. Always consult with a healthcare provider for personalised guidance and support.

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ABOUT COL. (R) DR. MOHAMAD ANUAR BIN MOHAMAD, PUTRA MEDICAL CENTRE ALOR SETAR

Col. (R) Dr. Mohamad Anuar bin Mohamad holds a Bachelor of Medicine and Bachelor of Surgery from Quaid-I-Azam University and a Master of Medicine in Internal Medicine from Universiti Sains Malaysia. As a Fellow of Interventional Cardiology, he is affiliated with the Malaysia Medical Association and the US Army Medical Corps. Dr. Mohamad specialises in cardiology, providing expert care to his patients.

For information on cardiology care and other related professional healthcare services, visit the official website of Putra Medical Centre Alor Setar, or make a WhatsApp enquiry using the hospital’s careline.

For further details, visit our official social media:

For any medical assistance or advice, feel free to contact Putra Medical Centre:

Phone: +604-734 2888 | +6011-1052 3600 | +6011-1052 3688

Email: pmc@putramedicentre.com.my

Website: https://pmck.com.my

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