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Taking Coumadin

Coumadin (warfarin) helps keep your blood from clotting. It is used to reduce the risk for stroke, heart attack, or a blood clot passing to your lung. Coumadin also increases your risk of bleeding. Because of this, it must be taken exactly as directed by your doctor. You also need to protect yourself from injury.

Closeup of arm showing medical alert bracelet.

Follow These Tips

  • Take this medicine at the same time each day. Take it with a full glass of water, with or without food. If you miss a dose, contact your doctor immediately to find out how much to take. Never take a double dose.

  • Warfarin is an effective drug, but it can be dangerous if not taken properly. It makes your blood less likely to form clots. If you take too much, it can cause too much internal or external bleeding.

  • Be sure to tell all of your doctors that you take Coumadin. If you will be taking Coumadin for quite a while, carry an ID card or get a Medic-Alert bracelet. This will alert medical staff in case you aren’t able to do so yourself. Also carry with you the name and number of the person to contact in case of an emergency.

  • You will need to have regular blood tests to measure the effects of the warfarin. Keep your scheduled test appointment and be sure to talk with your doctor afterward to find out your results. Your doctor may need to change your dose. Follow your doctor’s advice exactly about how to take this medicine. Do not stop the medicine without talking with your doctor.

Monitoring Your PT/INR Blood Levels After Discharge

Two tests are used to find out how your blood is clotting. One is protime (PT) and the other is the international normalized ratio (INR).

  • Go for your blood (PT/INR) tests as often as directed. Note that diet and medication can affect your PT/INR level.

  • Your INR was between _____ and _____ .

  • Ask your doctor what your goal INR is. My goal INR is between _____ and _____.

  • My next PT/INR blood draw is due on _________________ (date) at ________________ (time) by ____________________ (name of doctor or clinic).

  • The name of the doctor who is monitoring my anticoagulation therapy is ______________________ and the phone number is ___________________.

  • Follow up with your doctor or as advised by his or her staff. It usually takes a few hours for your doctor to get the results of your clotting tests. Please call to get your lab results and find out if your doctor needs to make further changes to your Coumadin dose.

  • If your labs (PT/INR) are drawn at a location other than your doctor's office, please remember to tell your doctor as soon as you get your lab results.

 

What to Do at Home

  1. Adjust your Coumadin dose as directed by your doctor, ____________________ (name of doctor).

  2. Have another clotting test done every _______ days at _____________________ (name of clinic) by ____________________ (name of doctor).

  3. Do not go barefoot. Always wear shoes.

  4. Do not trim corns or calluses yourself.

  5. Always talk with your doctor before taking any herbs, vitamins, or prescription or over-the-counter (OTC) medications, especially aspirin and nonsteroidal anti-inflammatory drugs.

  6. Always talk with your doctor before stopping any medication or changing the dose of any of your medications.

  7. Use an electric razor instead of a manual one.

  8. Use a soft-bristled toothbrush and waxed floss.

  9. Avoid major changes in your diet.

 

When to Call Your Health Care Provider

Coumadin increases your risk of bleeding. Call your health care provider right away before you take your next dose of Coumadin if you have any of these problems:

  • Bleeding that doesn’t stop in 10 minutes

  • A heavier-than-normal period or bleeding between periods

  • Coughing or throwing up blood or something that looks like coffee grounds

  • Nausea, bloating, diarrhea, or bleeding hemorrhoids

  • Bleeding hemorrhoids

  • Dark red or brown urine

  • Red or black tarry stools

  • Red or black-and-blue marks on the skin that get larger

  • A fever or an illness that gets worse

  • Dizziness, headache, weakness, or fatigue

  • Chest pain or trouble breathing

  • A serious fall or a blow to the head

  • Swelling or pain after an injury or at an injection site

  • Bleeding gums after brushing your teeth

Keep Your Diet Steady

Keep your diet pretty much the same each day. That’s because many foods contain vitamin K. Vitamin K helps your blood clot. So eating foods that contain vitamin K can affect the way Coumadin works. You don’t need to avoid foods that have vitamin K. But you do need to keep the amount of them you eat steady (about the same day to day). If you change your diet for any reason, such as due to illness or to lose weight, be sure to tell your doctor.

  • Examples of foods high in vitamin K are asparagus, avocado, broccoli, cabbage, kale, spinach, and some other leafy green vegetables. Oils, such as soybean, canola, and olive oils, are also high in vitamin K.

  • Other food products can affect the way Coumadin works in your body:

    • Food products that may affect blood clotting include cranberries and cranberry juice, fish oil supplements, garlic, ginger, licorice, and turmeric.

    • Herbs used in herbal teas or supplements can also affect blood clotting. Keep the amount of herbal teas and supplements you use steady.

    • Alcohol can increase the effect of Coumadin in your body.

Talk with your health care provider if you have concerns about these or other food products and their effects on Coumadin.

What to Watch For

If you have any of these signs or reactions, call your doctor right away or go to the hospital.

Signs of too much bleeding:

  • More bruising than normal

  • Prolonged bleeding from cuts

  • Bleeding from the nose or gums

  • Blood in your urine, vomit, or stools (red or black color)

  • Coughing up blood

  • Unusually heavy menstrual bleeding

  • Sudden change to a dark or purplish color in your toes or any other area of your body

Allergic Reactions:

  • Rash

  • Itching

  • Swelling

  • Trouble swallowing or breathing

********** IMPORTANT **********

Medical Conditions

Before starting this medicine, be sure your doctor knows if you have any of these conditions:

  • Stomach ulcer now or in the past

  • Vomited blood or had bloody stools (black or red color)

  • Aneurysm, pericarditis, or pericardial effusion

  • Blood disorder

  • Recent surgery, stroke, mini-stroke, or spinal puncture

  • Kidney or liver disease, uncontrolled high blood pressure, diabetes, vasculitis, congestive heart failure, lupus or other collagen-vascular disease, or high cholesterol

  • Pregnancy or breastfeeding

  • Younger than 18 years old

  • Recent or planned dental procedure

Drug Interactions

Many medicines interfere with the effect of Coumadin. Before starting this medicine, be sure your doctor knows about any prescription, OTC, or herbal drugs you are taking. This is especially true if you are taking:

  • Antibiotics

  • Heart medicines

  • Cimetidine (Tagamet)

  • Aspirin or other anti-inflammatory drugs such as ibuprofen (Advil, Motrin, or Nuprin), naproxen (Aleve, Naprosyn, Anaprox), ketoprofen (Orudis, Oruvail), or other arthritis medicines

  • Drugs for depression, cancer, HIV (protease inhibitors), diabetes, seizures, gout, high cholesterol, or thyroid replacement

  • Vitamins containing Vitamin K or herbal products such as ginkgo, Q10, garlic, or St. John's wort

[NOTE: This information topic may not include all directions, precautions, medical conditions, drug/food interactions, and warnings for this drug. Check with your doctor, nurse, or pharmacist for any questions that you may have.]      

 

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