Oops! I Missed My Medication… What Should I Do Now?

If you have recently experienced a blood clot, you’re most likely being treated to prevent future blood clots as your body recovers and heals. The standard treatment for blood clots, including blood clots in the legs or arms (deep vein thrombosis or DVT) and blood clots in the lung (pulmonary embolism or PE), is taking a prescribed medication called an anticoagulant, or what most people refer to as a “blood thinner.” However, anticoagulants do not thin the blood. They instead cause the blood to take longer to form a clot. Remember, clotting is a necessary process that your body needs (to stop bleeding and heal wounds, for example), so we don’t want to eliminate it completely. However, excessive clotting or clotting in places where we shouldn’t, like DVT and PE, can lead to serious health consequences and must be treated and prevented. So, if you’re here because you missed your medication, it can be very overwhelming.

Before we get to managing a missed or skipped dose, let’s talk a little bit about what anticoagulants are and how they work. If you’re here because you missed your medication, scroll down for some steps you can take now to get it resolved. If you miss a dose, the standard advice is to call your healthcare professional (doctor, pharmacist, or nurse line) for advice.

Thankfully, many anticoagulant medications exist to treat and prevent blood clots. Warfarin is the most commonly prescribed oral anticoagulant. It decreases the body’s ability to form blood clots by blocking the formation of vitamin K–dependent clotting factors. It is usually taken once a day and requires regular testing of the international normalized ratio (INR) blood test to tell you how long it takes for your blood to clot. A test called the prothrombin time (PT) actually measures how quickly your blood clots to ensure it is working properly. People who take warfarin need to be aware of their INR or have an idea of what it is at any given time. The standard INR range is 2.0-3.0 for most people on warfarin, but your range my be slightly different, so check with your doctor. My INR actually runs a little higher because I have antiphospholipid syndrome as a risk factor for clotting.  

In addition to needing monitored, warfarin works best when you eat about the same amount of vitamin K in your food every day. You should tell your doctor before changing your diet drastically and avoid big changes in how much vitamin K you eat. Some foods that have a high amount of vitamin K are asparagus, broccoli, brussels sprouts, cabbage, and green leafy vegetables like spinach. People taking warfarin typically do not need to avoid vitamin K, or these foods, entirely, but instead be aware the amount they are consuming and try to stay consistent. You should also talk to you doctor if you plan to take any herbal supplements or drink large amounts of alcohol as these can also interfere with the way warfarin works.

Direct oral anticoagulants (DOACs) such as dabigatran, rivaroxaban, apixaban, edoxaban, apixaban, and betrixaban are newer anticoagulants that work well for many people. These drugs intervene directly in the coagulation cascade and inhibit directly specific clotting factors such as Factor Xa and Factor IIa (thrombin). Unlike warfarin, DOACs no not require regular blood monitoring for dosing and are generally not impacted by food or alcohol like warfarin is. However, they have a shorter duration of action compared to warfarin, making it very important to take them as prescribed as missing a dose could increase the likelihood of experiencing a blood clot. Additionally, some DOACs require two doses a day, which can lead to a higher likelihood of missed or skipped doses. As the saying goes, when you have more to remember, you have more to forget.

There are also injectable blood thinners that you can take at home, like low molecular weight heparin, for example. Like with any oral anticoagulant, it is important to follow your dosing schedule when you are prescribed injected medications too.

Anticoagulants of all types need to be taken exactly as prescribed, and you should never increase or decrease your dose unless told to do so by your health care professional. Missing or skipping a dose can increase a person’s risk for clotting, and is in fact one of the main causes of a blood clot happening again (recurrence). So, when we miss a dose, or can’t remember if we took our dose, it can feel overwhelming and maybe even a little bit frightening.

I have missed my medication more than once. When it happens, it helps me to take a deep breath and remember: I am not perfect. I have been through this before. It will be okay. I have been taking warfarin for more than 10 years, so I am adept at adjusting my dose myself; however, if I’m not sure or become really worried about it, I still rely on my hematologist’s office to help me figure out how to get back on track. If I don’t know what to do, I wait until I can talk to my hematologist, or my pharmacist, before making a decision.

Missed Your Medication? Here Is What You Can Do:

  • Call your pharmacist. This is often the easiest and fastest way to get an answer. They are trained medical professionals who are specialists in medication management. They will tell you exactly what to do and they get these questions frequently, so don’t be afraid or embarrassed to ask.
  • Call your doctor’s office. They will often advise you via phone. If you take warfarin and get your INR monitored at an anticoagulation clinic, you can also contact the clinic.
  • Look at the medication’s prescribing instructions. These instructions usually come with your medication, or if you don’t have them available, you can look them up from the manufacturer or distributor online. It is still a good idea to discuss your medication schedule with a healthcare professional, but these prescribing guides can help you know what to expect or help you out in a pinch.
  • Call a nurse line. If you have health insurance and your insurance provider has a nurse line, you can call them for guidance. Many offer assistance and advice 24/7. In addition, some health insurances offer free, online or virtual consultations with a doctor who you can speak with about your missed medication.

Taking too much of your anticoagulant can increase your risk of serious bleeding. If you’re concerned you overdosed or took too much of your medication, call your doctor. You can also call or chat with poison control for immediate assistance. You should never try to force yourself to expel the medication though vomiting or other means. Try to remain calm while waiting to speak to a healthcare provider. Reversal agents, as they are called, exist for most anticoagulants, and can be used in very extreme situations of an overdose. If you’re concerned about serious or life-threatening bleeding, call 911 or go to the nearest emergency room or hospital.

Most situations of skipping or missing a medication dose, or even taking too much of your anticoagulant, are correctible at home. In addition, there are several things you can do to not miss your medication in the first place, even though it happens occasionally (and it’s okay). It is important not to let missing your medication become a habit. I use a pillbox to remember to take my pills, but every once in a while, I still fall asleep or get really busy and it completely slips my mind. You can read more about how to manage your medication schedule in this blog post

Finally, cost can be prohibitive for some people, especially if you are taking a DOAC, but that should not stop you from taking your medication. Talk to your doctor if you need help affording your medication and visit these prescription assistance resources.

You can read more helpful information about managing anticoagulants here:

There is hope for healing from blood clots, and you are not alone.