Walking while taking anticoagulants: how to stay safer

Walking on anticoagulants: the essentials

If your doctor hasn’t limited your activity, a regular walk is usually possible. Rather than trying to “make up for” the risk by becoming completely inactive, focus on reducing the chance of a fall and knowing in advance what to do after an injury. Clinical guidance on caring for people with venous thromboembolism supports mobility when there are no medical reasons to avoid it, and specifically recommends that clinicians assess fall risk in people taking anticoagulants.

Anticoagulants—such as warfarin, apixaban, rivaroxaban, dabigatran, or edoxaban—make blood clots less likely to form, but increase the chance of bleeding. Aspirin and clopidogrel are antiplatelet medicines, not anticoagulants; they can also affect bleeding. If you take more than one of these medicines, tell your doctor about each one.

The main idea: don’t give up movement because of a pill. Make a fall less likely, and don’t overlook the effects of an injury.

What the medication changes—and what it doesn’t

The medication itself usually doesn’t change your usual walking pace or mean you need a special “anticoagulant-friendly” route. What changes is the potential impact of an injury: even a fall from standing height that involves a blow to the head needs attention, because bleeding may not be immediately noticeable. This doesn’t mean every bump will lead to complications, but it does mean you can’t judge an injury only by how well you feel.

The prospective study included people who hit their heads after falling from standing height and went to an emergency department for a CT scan. Bleeding was found in 33 of the 939 participants. This isn’t an estimate of the chance of being injured during an ordinary walk or a precise prediction for any individual: participants were taking different anticoagulant and antiplatelet medicines, and they were examined after a head injury.

The practical takeaway is simpler than trying to calculate your own odds: if you hit your head, seek urgent medical assessment, even if there’s no obvious wound or severe pain. A clinician will decide whether you need monitoring or tests. NICE guidance advises considering referral to an emergency department after a head injury in people taking anticoagulants; this doesn’t mean that everyone necessarily needs a CT scan.

Before you head out: a quick check

Before a walk, check how you’re feeling as well as the weather. If you’re dizzy, weak, unsteady, or feeling unusually unwell, find out why before testing yourself outdoors. If you’ve fallen recently or are losing your balance more often, ask a doctor or physical therapist to assess your gait and fall risk. APTA guidance specifically recommends that clinicians carry out this assessment for people taking anticoagulants; it’s a reason to discuss your risk, not a recommendation to stop walking.

• Check that your phone is charged and that you can make an emergency call without unlocking the screen.
• Carry a medical ID card or wear a bracelet with the name of your anticoagulant and an emergency contact.
• Save a list of your medicines on your phone: the name, dose, and usual time you take each one. Don’t rely on your memory if you feel confused after a fall.
• If you’ve fallen before, fainted, or had balance problems, walk with someone you trust or tell someone your route and when you expect to return.
• Take your medicine as prescribed. Don’t skip or change a dose for a walk unless your doctor tells you to.

If you take warfarin, continue your prescribed INR monitoring and follow your clinic’s instructions. If your result is outside your personal target range or the clinic gives you new instructions, ask what to do about physical activity. INR isn’t used to routinely adjust the dose of direct oral anticoagulants; that doesn’t mean you can skip regular appointments or discussions about side effects. Don’t try to judge how well the medicine is working by how you feel.

Route and pace: lower your risk of falling

Choose a familiar, level route with a good surface and places where you can stop or go indoors. Darkness, icy conditions, heavy rain, and poorly lit stairs make tripping more likely—consider postponing your walk or choosing a safe indoor route in these conditions. For more ideas, see our articles on walking surfaces and walking on ice.

• Wear shoes that fit, have stable soles, and hold your feet securely in place; don’t go out in slippers or slippery shoes.
• Take your time on turns, curbs, and stairs. Watch the path ahead, not your phone.
• If your balance has been unreliable, don’t take a difficult trail, steep slope, or loose-surface route alone.
• Use a cane or walker if one has been recommended for you. If you need support but aren’t sure which kind is right, discuss it with a clinician. Learn more in our article on walking with a cane.
• Keep to a comfortable, familiar pace. Don’t add intervals, a long route, or an unfamiliar area on a day when you feel unsteady.

If you’re older, have started tripping more often, or are afraid of falling, changing your route may not be enough. Global recommendations for fall prevention in older adults include personalized exercises that train balance and functional movement. This doesn’t necessarily mean following a workout video on your own: ask a doctor or physical therapist to choose a safe option, especially if you’ve already fallen.

If you fall or hit yourself

First, stop and don’t get up suddenly. If you have severe pain, a visible deformity, weakness, confusion, or can’t get up safely, ask someone nearby to call for help. If you’re not sure whether you hit your head, or you can’t remember the fall, take extra care: tell a medical professional that you take an anticoagulant and get advice urgently.

Don’t stop, delay, or take an extra dose of your anticoagulant on your own after a fall. What to do about the medicine depends on why it was prescribed and the type of injury. Even if you think you should stop treatment “just in case,” get instructions from a doctor first.

When to get urgent help

Call your local emergency service if you have signs of possible serious bleeding or a head injury. Don’t try to decide on your own whether it’s related to your medicine: tell the dispatcher and medical team that you take an anticoagulant.

• loss of consciousness, seizures, unusual drowsiness, or confusion after a fall;
• a severe or worsening headache, or repeated vomiting;
• new weakness or numbness, or problems with speech, vision, coordination, or balance;
• blood in your urine or stool, black stools, vomiting blood, or coughing up blood;
• heavy bleeding that won’t stop, or rapidly increasing painful swelling or bruising.

For less severe but unusual bleeding, frequent bruising, or repeated nosebleeds, contact your doctor or anticoagulation clinic soon. Keep a note of what happened and when, but don’t delay seeking help if your symptoms get worse. The NHS specifically advises people taking warfarin to report bleeding and seek help after a head injury; the exact steps depend on your country and local healthcare system.

In brief: safer walks on anticoagulants

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