Anticoagulant Suggestions for Adults with Swallowing Difficulties

20 June, 2024

The Specialist Pharmacy Service (SPS) has provided guidance on anticoagulant options for adults who have difficulty swallowing. This article summarises the key points from the guidance, offering practical solutions to ensure safe and effective anticoagulation therapy for patients with swallowing difficulties.


Anticoagulants are vital for preventing and treating blood clots, but patients with swallowing difficulties face challenges in taking these medications. The SPS guidance offers recommendations to help healthcare providers manage anticoagulation therapy in these patients, ensuring they receive appropriate care without compromising efficacy or safety.

Challenges of Swallowing Difficulties

  • Medication Adherence: Patients with dysphagia may struggle to adhere to their anticoagulant regimen, increasing the risk of thromboembolic events.
  • Risk of Aspiration: Swallowing difficulties can lead to aspiration, where medication enters the lungs, potentially causing respiratory complications.

Oral Anticoagulant Options

  • Direct Oral Anticoagulants (DOACs): Some DOACs, such as apixaban and rivaroxaban, can be crushed and mixed with water or soft foods, making them easier to swallow.
    • Apixaban: Can be crushed and mixed with water, apple juice, or applesauce.
    • Rivaroxaban: Can be crushed and mixed with water or apple puree; also available in granule form for oral suspension.
  • Warfarin: Available in liquid form, providing an alternative for patients who cannot swallow tablets.

Non-Oral Anticoagulant Options

  • Subcutaneous Injections: Low molecular weight heparins (LMWHs) like enoxaparin can be administered via subcutaneous injection, bypassing the need for oral intake.
  • Intravenous Anticoagulants: Options like unfractionated heparin can be administered intravenously, suitable for inpatient settings.

Practical Recommendations

  1. Assess Swallowing Ability: Conduct a thorough assessment of the patient’s swallowing ability to determine the most suitable form of anticoagulant.
  2. Consider Patient Preferences: Engage with patients to understand their preferences and comfort with different administration methods.
  3. Review Formulations: Evaluate the available formulations of prescribed anticoagulants and choose the most appropriate option.
  4. Provide Instructions: Offer clear instructions on how to take modified formulations (e.g., crushed tablets) to ensure effectiveness and safety.
  5. Monitor Therapy: Regularly monitor anticoagulant therapy, especially when switching formulations, to ensure therapeutic levels are maintained and to manage any side effects.

Patient Education and Support

  • Educate Patients and Caregivers: Provide education on the correct administration of anticoagulants, potential side effects, and the importance of adherence to therapy.
  • Support Services: Offer access to support services such as speech and language therapists who can assist with swallowing difficulties.


Managing anticoagulation therapy in patients with swallowing difficulties requires a tailored approach to ensure safety and efficacy. By following the SPS guidance and considering alternative formulations and administration methods, healthcare providers can optimise treatment outcomes for these patients.

Read more: Anticoagulant suggestions for adults with swallowing difficulties – SPS – Specialist Pharmacy Service – The first stop for professional medicines advice

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