Anticoagulant Injection Instructions Using a Prefilled Syringe

Injectable blood thinners (anticoagulants) are medicines to help prevent and treat blood clots. Injectable anticoagulant medicines are given with a single-use syringe that already has medicine inside it (prefilled syringe). You inject the medicine through a needle into the layer of fat and tissue between skin and muscle (subcutaneous) in the left or right area of your abdomen.

Before you give yourself your first injection, your health care provider will show you how to take your anticoagulant medicine at home. Make sure to read the instructions in the package insert that comes with the prefilled syringe. Follow the instructions about how to prepare and give the injection.

What are the risks?

Generally, self-injection of anticoagulant medicine is safe. However, mild problems can occur, including mild bleeding, itching, or rash at the injection site.

• Bleeding and bruising.
• An allergic reaction to the medicine.
• A low platelet count (thrombocytopenia).
• A low red blood cell count (anemia).
• Liver injury.
• Stroke.

General tips

• Do not use the syringe or needle more than one time.
• Change the injection site each time you give yourself a shot.
• Before an injection, make sure the medicine is clear and colorless or a pale yellow. Do not use your medicine if it is discolored or has particles in it, and contact your health care provider if this happens.

Supplies needed:

• Alcohol wipes.
• A prefilled syringe with needle.
• A container for syringe disposal. Used syringes must be disposed of in a sharps container. This is a puncture-proof, hard-sided plastic container with a lid.

How to inject anticoagulant medicine

1. Wash your hands with soap and water for at least 20 seconds. If soap and water are not available, use hand sanitizer.
2. Sit down or lie down.
3. Locate the site on your left or right area of the abdomen where the medicine should be injected. Avoid the area within 2 inches (5 cm) of your belly button.
4. Use an alcohol wipe to clean the site where you will be injecting the needle. Let the site air-dry. Do not blow on this area.
5. When using a prefilled syringe, the needle should be pointed down to make sure that the air bubble is at the top of the liquid. Do not remove the air bubble before giving the injection. The bubble will be injected after the liquid. You may need to tap the syringe with your finger to move the bubble to the top of the liquid.
6. If your syringe has only a plastic cover over the needle, pull the cover straight off the needle on the syringe.
7. If your prefilled syringe has a rigid needle guard covering the needle, hold the syringe with one hand and use your other hand to twist the needle guard counterclockwise. Pull the guard straight off the needle and throw it away.
8. Do not touch the needle with your fingers or allow it to touch anything else.
9. Hold the syringe in your writing hand like a pencil.
10. Use your other hand to pinch and hold the area you previously cleaned with alcohol. This should be about an inch (2.5 cm) of skin. Do not directly touch the cleaned part of the skin.
11. Insert the entire needle straight into the fold of skin. The needle should be at a 90-degree angle (perpendicular) to the skin. Push the needle all the way against the skin.
12. After the needle is completely inserted into the skin, use the thumb or index finger of your writing hand to push the plunger all the way into the syringe to inject the medicine. Continue to push the plunger until the syringe is empty.
13. Pull the needle straight out of the skin at the same angle that it was inserted, and release the skin fold.
14. Press and hold an alcohol wipe, a cotton ball, or a piece of gauze over the injection site until the bleeding stops. Do not rub or massage the area.
15. Do not recap the needle.
16. If your syringe has a safety system for shielding the needle after injection:
    • Firmly push down on the plunger after you complete the injection. The protective sleeve will automatically cover the needle, and you will hear a click. The click means that the needle is safely covered.
    • Do not activate the safety system until the needle is away from your skin.
17. Place the syringe and needle in the sharps disposal container. Donot throw it away in the garbage.
18. Cover the injection site with a bandage, if needed.

Follow these instructions at home:

Bleeding precautions

• Talk with your health care provider before you take any medicines that contain aspirin or NSAIDs, such as ibuprofen. These medicines increase your risk for dangerous bleeding.
• Take your medicine exactly as told, at the same time every day.
• Avoid activities that could cause injury or bruising, and follow instructions about how to prevent falls.
• Wear a medical alert bracelet or carry a card that lists what medicines you take.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Tell all your health care providers, including dentists:
  • That you are taking an anticoagulant, especially if you are injured or plan to have a procedure.
  • If there is a change in your illness, and any other changes in medicines, supplements, or diet.
• Store your medicine at room temperature and keep it out reach of children.
• Keep all follow-up visits. This is important. This includes visits for lab tests.

Contact a health care provider if:

• You have large areas of bruising on your skin or a cut that will not stop bleeding.
• You develop any rashes on your skin.
• You develop a fever.
• There is a small amount of blood in your urine. If this happens, your urine may look a little pink.

Get help right away if:

• You develop bleeding problems such as:
  • Vomiting blood or coughing up blood.
  • Vomiting a substance that looks like coffee grounds.
  • Having dark red blood in your urine.
  • Having blood in your stool (feces), or your stool has a dark, tarry appearance.
• You have bleeding that does not stop.
• You develop chest pain or shortness of breath.
• You fall and hit your head.
• You develop a severe headache or confusion.
• You develop sudden numbness or weakness.
• You have trouble walking.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.). Do not drive yourself to the hospital.

Summary

• Injectable blood thinners (anticoagulants) are medicines that help prevent blood clots from developing in the veins.
• You inject the medicine through a needle into the layer of fat and tissue between skin and muscle (subcutaneous) in your abdomen.
• Keep all follow-up visits. This is important. This includes visits for lab tests.