Anticoagulants: How can you prevent bleeding?

Anticoagulants (anti-clotting medications) slow down the blood-clotting process. But taking them also means your body needs longer to close wounds and stop any bleeding. So bleeding is one of the most common side effects, especially in the digestive tract. There are quite a few things you can do to lower the risk of bleeding and detect it at an early stage.

If you take anticoagulants, it’s a good idea to always have your medical ID card with you. This card is called Medikamentenpass in German. It includes information about things like the illness you’re taking the medication for, what dosage you need and who your doctor is. So emergency medical staff can see straight away whether you take anticoagulants and can act quickly if you’re injured. Your doctor can give you one of these cards.

How can you reduce the risk of bleeding?

Alcohol can affect your blood's clotting ability and increase the risk of bleeding. So it’s best to avoid it completely or only drink small amounts. High blood pressure also increases the risk of bleeding so it’s important to get proper treatment for that if you have it.

Physical activity and sports do not directly affect blood clotting. But the risk of injury is higher in some sports, which means the risk of bleeding is higher too. So it’s worth considering doing sports that don’t have such a high risk of injury.

As a general rule, the more medications you take, the higher the risk of side effects and interactions between them. Because of this, it makes sense to draw up a medication schedule and discuss it with your doctor on a regular basis.

How can you detect dangerous bleeding?

The signs can differ greatly, depending on where the bleeding occurs. Light nosebleeds, gum bleeding or bruises on the skin are generally not a problem. But heavier bleeding has to be treated quickly.

It is important to consult a doctor if you notice any of the following:

  • Heavy, persistent bleeding from the nose or gums
  • Major bruising
  • Red urine
  • Blood in your stool (dark red or black stool)
  • Blood in vomit

In very rare cases, anticoagulants can cause bleeding in the brain (brain hemorrhage). Then it’s important to react quickly and call the emergency services right away (112 in Germany and many other countries, 911 in the U.S.) – as you would for a stroke. Symptoms include:

  • Severe, sudden headache
  • Vision problems, feeling faint, signs of paralysis or numbness
  • Confusion or slowed-down responses
  • Seizures

What should you keep in mind before surgery and other procedures?

If you’re due to have major surgery or another procedure (a gastroscopy, for example), you might have to stop taking your anticoagulants or adjust the dosage a few days beforehand. So it’s important to tell the doctor that you're taking anticoagulants in plenty of time before the procedure. It can also be helpful to show them your medical ID card.

You don’t necessarily have to stop taking the medication if you’re having a more minor procedure or dental treatment. But even then it’s better to let your doctor know beforehand that you take anticoagulants. That gives the doctor the chance to prepare in case any problems do occur during the treatment. You should also tell them before you have any injections or vaccinations. This is because, for example, an injection into a muscle could cause more severe bleeding if you’re using anticoagulants.

Arzneimittelkommission der deutschen Ärzteschaft (AkdÄ). Leitfaden: Orale Antikoagulation bei nicht valvulärem Vorhofflimmern. Empfehlungen zum Einsatz der direkten oralen Antikoagulanzien Dabigatran (Pradaxa®), Apixaban (Eliquis®), Edoxaban (Lixiana®) und Rivaroxaban (Xarelto®). 2019.

Eikelboom JW, Hirsh J, Spencer FA et al. Antiplatelet drugs: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141(2 Suppl): e89S-e119S.

European Society of Cardiology (ESC), Deutsche Gesellschaft für Kardiologie (DGK). Management von Vorhofflimmern (ESC Pocket-Guidelines). 2016.

Kasper DL, Fauci AS, Hauser SL et al. Harrison's Principles of Internal Medicine. New York: McGraw-Hill; 2015.

Kirchhof P, Benussi S, Kotecha D et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur J Cardiothorac Surg 2016; 50(5): e1-e88.

Konstantinides SV, Meyer G, Becattini C et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J 2020; 41(4): 543-603.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Created on December 15, 2022

Next planned update: 2025


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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