Around 30% of people started on a long-term anticoagulant have stopped taking it by three months. This is not merely missing a few tablets or reaching the end of the time you needed anticoagulants for, but deliberately stopping while you’re meant to be taking them. And of course once people are no longer anticoagulated they’re at risk of a life-threatening stroke (if they have atrial fibrillation) or pulmonary embolus.
In a classic review study published in the New England Journal of medicine, Osterberg highlighted the following excuses:
1. I don’t feel unwell so why take medication?
You’re much more likely to take a medicine when you feel unwell: if you’re feeling dreadful and unable to get out of bed because you’ve got a chest infection, you’ll probably take your antibiotics: if you’ve got a cracking headache, you’ll take your painkillers.
There are many medications that people need to take even if they don’t feel unwell. This website is about anticoagulants, but statins, anti-hypertensive drugs and anti-epileptics are other common examples.
It may help if you educate yourself about why you need the drug. The more vital you believe it to be, the more likely you are to take it. Most people with cancer don’t forget their drugs. We knew a four-year-old little girl who hated taking even liquid medicine, so her parents just gave up. But once she had leukaemia, her parents had a much great incentive; their daughter never missed a dose and even learnt to swallow tablets.
2. I couldn’t care less
People with mental health issues, especially depression were less likely to take medication. If you feel like you couldn’t care less about medication, especially if you feel like this about other areas of your life too and have lost that spark of joy, then it’s important to be checked out for depression by your doctor. Depression can be a side effect of drugs or part of convalescence from major illnesses such as pulmonary embolus.
3. I don’t understand why I need to take it.
People with poor relationships with their doctors and those with cognitive impairments were less likely to take medication. It is important that doctors explain things in a simple, understandable style. And it is important that their patients hold them accountable to this. Hopefully this website will help you understand the need for anticoagulants.
If you are supporting someone with Alzheimer’s disease or an intellectual disability, then take your time explaining things in very simple terms.
Our seventeen-year-old son, Noah, who has Down syndrome, was put on medication for impulsivity. This was quite a complex idea to explain, but once he understood (we said, his brain said ‘go, go, go’ and the tablets said ‘wait, wait, wait’) he had no issues with taking his tablets.
4. I get horrible side effects
It’s a double whammy: You don’t feel unwell if you don’t take your tablets, but if you do make yourself take them, you’re hit with side-effects and then you do feel unwell. Lots of side-effects may be manageable in the short term but when you know you need the drug for life it becomes much more difficult. If you cannot find a way to enjoy life with these side-effects, ask your doctor about a possible alternative.
5. It’s just too complicated
Patients starting warfarin may find it very complicated at first, getting regular blood tests, maybe having to take different amounts of warfarin on different days and learning about the many drug and food interactions there are. This was the main reason for introducing the newer anticoagulants such as Pradaxa , Xarelto and Eliquis, which don’t need to have blood test monitoring or dose changes. Doctors speculated that warfarin use might go out of fashion, but this doesn’t seem to be happening so far. Many people chose to continue on warfarin as they were used to it and got few side-effects, for some conditions (eg heart valve replacement) warfarin is the only approved anticoagulant and some people (about 25% of users) switched from the new anticoagulants for various reasons.
If you’re on warfarin, you could consider self-testing using a finger-prick blood test machine: This has been shown to give the best warfarin management results and is very common in countries such as Germany. If you live in New Zealand, we sell self-testing equipment from this site. Also in New Zealand you can use your local pharmacy to have a finger-prick test and get your new warfarin dose immediately.
Other ways to make taking anticoagulants less complicated are
- Get your pills blister packed by your pharmacist or put them in 7-day pill organisers yourself
- Use an app (ours is here) or set an alarm on your phone to remind you to take your pills
- Print out a pill calendar and stick it to your fridge so you can cross off your pills once you’ve taken them.