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CION Cancer Clinics
Bleeding on a blood thinner: what to do right now | CION Cancer Clinics
Go to the nearest emergency department or call 108 if you take a blood thinner and the bleeding will not stop with firm pressure, your stools turn black, you vomit blood, you see blood in your urine, or you have hit your head. Do not wait to see whether it settles. Carry your medicine strip and say when you took the last dose. The team can often reverse the effect. At CION Cancer Clinics, our haematology team supports patients and families through treatment, cost questions and life at home.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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On this page
- Is this bleeding an emergency?
- What does serious bleeding look like in different parts of the body?
- What happens when you reach the hospital?
- What do the words on the emergency notes mean?
- What do families often get wrong about bleeding on blood thinners?
- What happens after the bleeding is under control?
- Common questions about bleeding on blood thinners
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If you are bleeding on a blood thinner, act now
Call 108 or go to the nearest emergency department straight away if the bleeding will not stop with firm pressure, if you vomit blood or something that looks like coffee grounds, if your stools are black or bloody, if you have hit your head, or if you have a sudden severe headache. Press hard on any wound while you wait. Take your medicine strip with you and tell the team what you take and when you last took it.
The short answer
Is this bleeding an emergency?
Heavy bleeding, bleeding that will not stop, or bleeding from inside the body is an emergency when you take a blood thinner. Small bruises and a brief nosebleed that stops with pressure usually are not, but you should still tell your doctor the same week.
Why blood thinners change the picture
A blood thinner, which doctors call an anticoagulant, slows the way your blood forms clots. That is what protects you from a stroke or a clot in the leg or lung. The same effect means a cut bleeds longer, and bleeding inside the body can keep going quietly. You may not see it. You may only feel weak, dizzy or breathless.
Which medicines this page is about
Warfarin, apixaban, rivaroxaban, dabigatran and edoxaban are taken as tablets. Heparin and enoxaparin are given as injections. Aspirin, clopidogrel and ticagrelor work in a different way, on the tiny blood cells called platelets, but they raise bleeding risk too, and more so when taken together with an anticoagulant.
This page describes warning signs. It cannot tell you whether your own bleeding is serious. When in doubt, go.Not sure whether this applies to you?
Ask an oncologistWarning signs
What does serious bleeding look like in different parts of the body?
Some bleeding is easy to see. Some shows up only as a change in how you feel. Each of these needs same-day care.
Stomach and bowel
Blood from the gut often does not look red. It can turn stools black and sticky like tar, or make vomit look like coffee grounds.
Go to hospital if you notice
- Black, tarry or bloody stools
- Vomiting blood or dark grains
- Fainting or feeling faint on standing
Head and brain
A sudden severe headache, new confusion, weakness on one side, slurred speech, repeated vomiting or a seizure can all mean bleeding inside the skull. Call 108 rather than travelling by auto.
Urine, cough and nose
Red or dark brown urine, coughing up blood, or a nosebleed that keeps going despite firm pinching of the soft part of the nose all need to be seen the same day.
Skin and joints
A large swelling that grows under the skin, a painful swollen joint without an injury, or bruises appearing all over without a reason can mean the blood is much thinner than intended.
At the emergency department
What happens when you reach the hospital?
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You are checked for how much blood you have lost
The team looks at your pulse, blood pressure and breathing first, and presses on or packs any bleeding they can reach.
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They ask what you take and when
The name of the medicine and the time of the last dose decide what comes next. Show the strip or a photo of the prescription.
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Blood tests
A blood count shows how much haemoglobin, the part of blood that carries oxygen, you have left. Clotting tests show how thin the blood is. For warfarin this is the INR.
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The effect may be reversed
For serious bleeding, doctors can give treatments that undo the blood thinner. Vitamin K and clotting factor concentrates are used for warfarin. Some newer tablets have their own specific reversal medicines.
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The source is found and treated
This can mean a scan of the head, a camera test of the stomach, or a transfusion if you have lost a lot of blood.
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On the report
What do the words on the emergency notes mean?
- Anticoagulant
- A blood thinner that slows the clotting proteins in your blood. Warfarin and apixaban are examples.
- Antiplatelet
- A medicine such as aspirin or clopidogrel that stops platelets sticking together. It is a different kind of blood thinner.
- INR
- A clotting test used for warfarin. A higher number means the blood is taking longer to clot. Your own target range is set by your doctor, and labs differ in how they report it.
- Reversal
- Treatment given in hospital to undo the effect of a blood thinner during serious bleeding.
Commonly believed
What do families often get wrong about bleeding on blood thinners?
"It is only a little blood in the stool, we will see tomorrow."
Bleeding from the gut is often much larger than it looks, because most of it stays inside. Black stools on a blood thinner need a doctor the same day, even if you feel well.
"He fell but there is no cut, so he is fine."
On a blood thinner, bleeding inside the head can start without any wound and show up hours later as sleepiness or confusion. A fall with a knock to the head needs checking the same day.
"She bled, so she should never take the tablet again."
The medicine was started to prevent a stroke or clot, and that risk has not gone away. Whether, when and how to restart is a decision for the treating team. Please do not stop or restart it on your own.
"A painkiller from the chemist will help the headache."
Some common painkillers, such as ibuprofen and diclofenac, add to bleeding risk. A sudden severe headache on a blood thinner needs hospital, not a tablet at home.
Being straight with you
What happens after the bleeding is under control?
Once the bleeding has stopped, the next question is how to keep you safe from both bleeding and clots. There is no single answer. It depends on why you were given the blood thinner, where you bled, and what caused it.
Why the blood thinner is not simply stopped for good
People take these medicines because of an irregular heartbeat, a past clot, a heart valve, or a clot risk linked to cancer and its treatment. Stopping for good can leave that risk unprotected.
When a haematologist helps
If you also have low platelets, a bleeding disorder, a blood cancer, or are having chemotherapy, the balance is harder to judge. A haematologist, a doctor who treats blood conditions, can look at the whole picture. At CION, Dr. Basudev Pokhrel and the haematology team review these cases and coordinate with your other doctors.
What this page cannot tell you
It cannot tell you whether your blood is too thin today, whether to take your next dose, or whether a symptom is safe to watch at home. Only a doctor who has seen you and your test results can say that.
Questions we are asked
Common questions about bleeding on blood thinners
My father is on a blood thinner and his nose will not stop bleeding. What do I do?
Sit him up, lean him forward, and pinch the soft part of the nose firmly without letting go for a good while. If it is still bleeding after that, or the bleeding is heavy, take him to the nearest emergency department or call 108. Carry his medicine strip so the team knows what he takes.
Should I skip my next dose after a bleed?
Please do not decide this on your own. Call the doctor who prescribed it, or ask the emergency team before the next dose is due. Missing doses can raise the risk of a stroke or clot, and taking one during an active bleed can make things worse. The right answer depends on your reason for taking it.
Are small bruises normal on blood thinners?
Bruising a little more easily is common and is not usually dangerous. Mention it at your next review. Large bruises appearing without any knock, bruises that keep spreading, or bruising together with bleeding gums, nosebleeds or dark urine are different, and need a doctor to check you soon.
Why are my stools black? Is it the blood thinner?
Iron tablets can darken stools, but black, sticky, tar-like stools on a blood thinner can be bleeding from the stomach or bowel. Treat it as bleeding until a doctor says otherwise. Go to hospital the same day, especially if you also feel dizzy, weak, breathless or faint.
Can the effect of a blood thinner be undone quickly?
Often, yes, in hospital. Warfarin can be reversed with vitamin K and clotting factor concentrates. Some newer tablets have specific reversal medicines, though not every hospital stocks them. This is one reason to go to a larger emergency department when bleeding is serious, and to say clearly which medicine you take.
I have cancer and low platelets as well as a blood thinner. Is my risk higher?
Usually, yes. Low platelets, which is called thrombocytopenia, and chemotherapy can both add to bleeding risk. Your oncologist or haematologist may adjust the plan around your counts. Do not change anything yourself, but ask what count they are watching for and what to do if you start bleeding.
Can I take a painkiller while on a blood thinner?
Ask your doctor or pharmacist before taking any painkiller. Some common ones, such as ibuprofen, diclofenac and aspirin, raise bleeding risk when combined with a blood thinner. Paracetamol is often used instead, but check what suits you, especially if you have liver or kidney problems.
What should we keep ready at home?
Keep a card or a phone note listing the blood thinner, the reason it was started, the prescribing doctor and the name of any other medicines. In an emergency, that saves time at triage and helps the team choose the right reversal treatment.
Your Haematologist
Meet CION's haematologist. One specialist for your blood report and your plan.
Dr. Basudev Pokhrel reviews blood counts, transfusion needs and blood disorders, and works with the CION tumour board on blood cancers.
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Where to find us
Our centres in and around Hyderabad
Addressed by landmark, because that is how this city navigates. A haematology consultation can be booked at any of these centres through one helpline, and your team will tell you where each test or treatment takes place.
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Sources
- NHS — Anticoagulant medicines
- NHS — Warfarin
- American Society of Hematology — Blood Clots
- NICE — Anticoagulation - oral (Clinical Knowledge Summaries)
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Benign Haematology EmergenciesEvery blood-related emergency in one placeHead Injury With Low Platelets or HaemophiliaWhy a knock to the head needs checking the same daySevere Bleeding With a Bleeding DisorderWhen the bleeding risk comes from the blood itselfEmergency Card for Blood Disorder PatientsA card to carry so triage knows what you take
Talk to us
On a blood thinner and worried about bleeding?
If it is happening now, call 108 or go to the nearest emergency department. For a review of your blood reports and treatment afterwards, call the helpline and we will connect you with CION's haematology team.