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Understanding Warfarin: Dosage, Monitoring, and Side Effects of Anticoagulation Therapy, Summaries of Cardiology

An overview of anticoagulation therapy using Warfarin (Coumadin®), including reasons for its use, how it works, dosing, monitoring through INR tests, side effects, and interactions with food, vitamins, and other medications. It emphasizes the importance of proper use and regular monitoring to minimize risks.

Typology: Summaries

2021/2022

Uploaded on 09/12/2022

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tiuw 🇺🇸

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Through Thick and Thin
Learning to Live with Warfarin
South Denver Cardiology Associates PC
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What is Anticoagulation?
Anti = against
Coagulation = blood clotting
An anticoagulant is a medication that
reduces the bloods potential to clot
Anticoagulants are often called
“blood-thinners”
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Through Thick and Thin

Learning to Live with Warfarin

South Denver Cardiology Associates PC

2

What is Anticoagulation?

  • Anti = against
  • Coagulation = blood clotting
  • An anticoagulant is a medication that

reduces the bloods potential to clot

  • Anticoagulants are often called

“blood-thinners”

3

Reasons for Anticoagulation Therapy

  • Deep Vein Thrombosis (DVT)
  • Mechanical Heart Valve Replacement
  • Pulmonary Embolus (PE)
  • Atrial Fibrillation (Afib)
  • Atrial Flutter (Aflutter)
  • Myocardial Infarction (MI) or Heart Attack

4

Reasons for Anticoagulation Therapy

  • Cardiomyopathy or Left Ventricular

Dysfunction

  • Stroke
  • Transient Ischemic Attack (TIA)
  • Post-operative

7

About Warfarin (Coumadin®)

  • Warfarin therapy monitored by blood test

called INR (International Normalized Ratio)

  • MD will prescribe what range INR needs to be
    • INR = 0.9-1.1, without warfarin
    • INR =2.0-3.0, for most indications
    • INR = 2.5-3.5, for mechanical heart valves and other conditions
    • general guidelines, may have different range according to medical condition or other risk factors

8

About Warfarin (Coumadin®)

  • Warfarin has a “narrow therapeutic range”
  • When INR falls within prescribed range,

level is “therapeutic”

  • When INR falls below prescribed range:
    • INR = 1.5, for example
    • blood is “too thick”, clotting too fast
    • risk for forming blood clots exists
    • warfarin dose needs to be increased

9

About Warfarin (Coumadin®)

  • When INR is above prescribed range:
    • INR = 4.5, for example
    • blood is “too thin”, clotting too slowly
    • higher risk for bleeding
    • warfarin dose needs to be decreased

10

About Warfarin (Coumadin®)

  • The dose of warfarin needed is the one that

will keep INR in therapeutic range

  • some people need very large dose of warfarin
  • some people need very small dose of warfarin
  • The dose of warfarin will fluctuate with

changing INR values

  • dose likely to change with each INR in first month of therapy
  • will change after first month with changes in diet, medications, activity and overall health

13

About Warfarin (Coumadin®)

  • When a stable dose of warfarin has been

found

  • INR needs to be checked once a month
  • If INR is stable for several consecutive months a 6-week schedule may be considered for INR’s
  • It is very important to call for earlier INR

appointment if there are changes

  • in diet, medications, activity and overall health

14

About Warfarin (Coumadin®)

  • If a dose of warfarin is missed it can be

taken later the same day

  • If previous days’ dose was missed
    • DO NOT TAKE A DOUBLE DOSE!
    • Get back on dosing schedule and let healthcare provider know the date of the missed dose with next INR

15

About Warfarin (Coumadin®)

  • If more than 1 or 2 doses are missed
    • call healthcare provider to discuss
    • INR may need to be checked
  • You are not likely to have symptoms if INR

is too low or too high

  • This is why regular testing of INR is so

important

16

Warfarin and Side Effects

  • The most common and serious side effect of

warfarin therapy is bleeding

  • The risk of bleeding is relatively small when warfarin is taken properly
  • To lower the risk, make sure to have INR levels checked regularly
  • Report any changes in diet, medications, activity and overall health

19

Warfarin and Side Effects

  • Any of these symptoms could be

significant, but may not be dangerous

  • In therapeutic doses warfarin does not cause

bleeding, but will make it harder to stop

bleeding if an injury occurs

  • Primary care physician (PCP) will need to

be aware of, and treat any of these side

effects

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Warfarin and Side Effects

  • For minor bleeding
    • nosebleed or bleeding gums that stop within a few minutes
  • Call healthcare provider so INR can be

checked

  • Reporting bleeding symptoms early and

having warfarin dose adjusted

  • can prevent INR from increasing and more serious side effects from occurring

21

Warfarin and Side Effects

  • GET TO THE NEAREST EMERGENCY

ROOM

  • If you have major bleeding
    • Nosebleed that does not stop after 15-20 minutes
    • Frank blood in stools, or black, tarry stools
    • Vomiting bright red or coffee-ground emesis
  • If you sustain a traumatic injury from a fall or car accident - You will need to be checked for internal bleeding

22

Warfarin and Side Effects

  • GET TO THE NEAREST EMERGENCY

ROOM

  • If you are exhibiting signs of a stroke or “brain attack” - Sudden numbness or weakness of face, arm or leg - Difficulty speaking or understanding others - Problems seeing clearly - Confusion, dizziness, severe drowsiness - Loss of coordination - Sudden severe headache with no known cause

25

Special Considerations with Warfarin

  • Advisable to wear a Medic-Alert bracelet
    • To notify emergency healthcare personnel you are taking anticoagulants
  • Have an updated medication list
    • In wallet or billfold and with you at all times
  • Be careful! Use common sense!
    • You are taking a blood thinner and are going to bruise more easily and bleed longer than before you took warfarin

26

Warfarin and Drug Interactions

  • Warfarin has hundreds of drug interactions
    • With prescription, over-the-counter and herbal medicines
    • Not all medications affect everyone the same
    • Initiation of some meds warrant an INR within 2-3 days
    • Initiation or change in others may need INR to be checked within 2 weeks

27

Warfarin and Drug Interactions

  • One of the most preventable causes of an

untherapeutic INR

  • Is to inform healthcare provider when making any medication changes, however minor they may seem
  • If you need to take a medication that

interacts with warfarin

  • You will need more frequent testing of INR and adjustment in dose until INR is stable

28

Warfarin and Diet

  • Warfarin works against vitamin K in diet
    • Vitamin K is important in forming blood clots
    • Foods with the highest amounts of vitamin K are green, leafy vegetables
  • Green vegetables are important!
    • Contain folic acid, phytonutrients and fiber
      • All of which help protect your heart and have countless other benefits to body
      • Eat your veggies!

31

Warfarin and Dietary Supplements

  • Dietary supplements such as Ensure, Boost,

Carnation Instant Breakfast, and various

protein drinks are ‘high’ in vitamin K

  • If you start a dietary regimen with any of these
    • Be consistent
    • Call healthcare provider, as warfarin dose will likely need to be adjusted

32

Warfarin and Vitamins

  • Multi-vitamins (MVI)
    • Contain vitamin K
    • Call healthcare provider if starting or changing
    • Pay attention to vitamin K content when choosing or switching brands
    • Viactiv MVI and Calcium chews have extremely high amounts of vitamin K
  • B Vitamins
    • Have little to no effect on warfarin

33

Warfarin and Vitamins

  • Vitamin C
    • Up to 500mg daily has no affect, greater than 500mg daily may effect warfarin dosage
  • Vitamin E
    • Up to 400 iu daily has no affect, doses greater than that may increase INR
  • Fish oil
    • Likely to increase INR and require dose adjustment

34

Warfarin and Alcohol

  • Drinking alcohol can affect INR and is not

always predictable

  • Best not to drink alcohol, but alcoholic

beverages in moderation can be safe

  • One or two drinks each day
    • 12 oz. Beer = 4 oz. Wine = 1 oz. Liquor
  • It is best to be consistent from week to week

37

Warfarin and Medical, Surgical

or Dental Procedures

  • Contact your healthcare provider any time

you need to have a procedure that puts you

at risk for bleeding

  • Warfarin may need to be temporarily stopped
  • It may not be safe for you to stop your anticoagulants entirely - You may need an alternative method of anticoagulation

38

Warfarin and Travel

  • Travel can often affect INR levels
  • Have INR checked before travelling
  • If an INR needs to be checked while away,

or you will be gone for an extended time

  • Your healthcare provider can help you make arrangements to have it checked while away
  • Try to maintain a consistent diet and avoid

excessive alcohol intake

39