[Learning Points]
- Non-vitamin K antagonist oral anticoagulant (NOACs) is a new direct oral anticoagulants(DOACs) that use to prevent thrombus pulmonary embolism, thromboembolism of deep vein and the ischemic stroke.
- Do not forget to take the medicine, you should take the medication once you recall it. If you forgot to take the medicines (Dabigatran, Apixaban), you can take the medication dose once you missed in six hours.
I. Purpose
- Non-vitamin K antagonist oral anticoagulant (NOACs) is a new direct oral anticoagulants(DOACs) that use to prevent thrombus pulmonary embolism, thromboembolism of deep vein and the ischemic stroke cause by non-valvular atrial fibrillation.
Non-vitamin K antagonist oral anticoagulant (NOACs)
II. Prevent notifications about daily medicine taking
- If you forget to take the medicine, you should take the medication once you recall it. If you forgot to take the medicines (Dabigatran, Apixaban), you can take the medication dose once you missed in six hours. Beside the medicine (Rivaroxaban, Edoxaban) can take in twelve hours. You should never take double of the prescription dose in the same day in order to make up for the missed dose .Do not adjust or stop taking medicine by yourself.
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DRUG
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TIME
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Dabigatran
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The dose missing in six hours
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Apixaban
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Rivaroxaban
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The dose missing in twelve hours
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Edoxaban
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- If any of the following symptoms occurs, please discontinue anticoagulant use and come back to the hospital immediately. Doctors will adjust the dose of medicine on the basis of your symptoms and examination result. Please obey doctors’ instructions to take medicine.
A.Nosebleed.
B.Blood in urine (Pink, red, or even bloody urine).
C.Tarry stool.
D.Vomiting with bloody vomitus.
E.Coughing up of blood.
F.Heavy menstrual bleeding.
G.Serious bruises on your skin.

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H.Allergy
I.General reaction: skin itchy, rash, hive; Local reaction: swelling (include face, lip, tongue, throat).
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J.Others: difficulty breathing, chest pain, leg edema, hepatic disease, ischemic or hemorrhagic stroke

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- Avoid those activities might cause trauma, injury, wound, and hemorrhage. For example, contusion, heavy massage, or cutting too hastily. You should choose soft toothbrush in avoidance of gingiva injury. Men should use electric shavers instead of razors for shaving.

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- If you are injured and start to bleed, please direct pressure on your wound for 10–15 minutes to stop bleeding.
- Before invasive treatment such as tooth extractions or surgeries, please inform your doctor in purpose to reduce the risk of bleeding (pause medicine and ask when to take it again).
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DRUG
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The days to be temporarily discontinued before procedure
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Rivaroxaban
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One to two days
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Apixaban
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Edoxaban
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Dabigatran
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One to four days
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- For patients with renal dysfunction, doctors will adjust the dosage based on your kidney function data.
- If you have the symptoms of cerebrovascular accident, such as difficulty walking, lose balance and coordination, difficultly speaking, paralysis in the face or serious bleeding, you need to back to the hospital immediately and accept the medical treatment.
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III. Conclusion
This brochure listed simple and common questions and answers about anti-coagulants. If you have any questions about the anticoagulant you take, include the dosage, appearance, and necessary information you can consult your nurse, pharmacists or doctors. They could provide you more detailed instructions.
IV. Reference
- 臺中榮民總醫院(2026)‧臺中榮總藥品手冊查詢系 統‧https://www.vghtc.gov.tw: 8080/ Pharmacy Handbook/handbook.html#/da0ta/LIX02。
- Lee, S. J., Yu, H. T., Lee, Y. J., Lee, S. H., Heo, J. H., Ahn, S. G., Shin, S., Doh, J. H., Her, A. Y., Cho, B. R., Kim, G. S., Kwon, T. G., Lim, S. W., Shim, J., Jang, J. Y., Lee, K., Cho, Y. H., Choi, C. U., Lee, S. R., Park, H. B., … ADAPT AF-DES Investigators (2026). Therapy for Atrial Fibrillation in Patients with Drug-Eluting Stents. The New England journal of medicine, 394(7), 658–668. https://doi.org/10.1056/NEJMoa2512091
- Lee, S. J., Yu, H. T., Lee, Y. J., Lee, S. H., Heo, J. H., Ahn, S. G., Shin, S., Doh, J. H., Her, A. Y., Cho, B. R., Kim, G. S., Kwon, T. G., Lim, S. W., Shim, J., Jang, J. Y., Lee, K., Cho, Y. H., Choi, C. U., Lee, S. R., Park, H. B., … ADAPT AF-DES Investigators (2026). Therapy for Atrial Fibrillation in Patients with Drug-Eluting Stents. The New England journal of medicine, 394(7), 658–668. https://doi.org/10.1056/NEJMoa2512091
- Karaszewski, B., Jabłoński, B., Gąsecki, D., Szczyrba, S., & Wyszomirski, A. (2026). Reperfusion thrombolytic therapy for ischemic stroke in patients on non-vitamin K antagonist oral anticoagulants: study protocol of a phase II randomized clinical trial. Trials, 27(1), 453. https://doi.org/10.1186/s13063-026-09699-z