A Patient s Guide to Using Warfarin

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Olivia Atkins
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Your Health Matters A Patient s Guide to Using Warfarin The purpose of this brochure is to inform you about your anticoagulation therapy to ensure its effectiveness and your safety.

1 Your Health Matters A Patient s Guide to Using Warfarin The purpose of this brochure is to inform you about your anticoagulation therapy to ensure its effectiveness and your safety. What is Warfarin & Why Do I Need it? Warfarin (brand name Coumadin ) is a medication that helps slow down the time it takes for your blood to clot. It works by decreasing the activity of certain blood clotting proteins that require the presence of vitamin K. A person s response to warfarin differs among people and requires individualized dosing. You need to take warfarin because your body has a condition that increases the chances of making blood clots, or you are being treated for a blood clot that has already formed. You may need to take warfarin for only a short period of time (a couple of months), or you may need to take warfarin for a longer period of time. Your healthcare provider will tell you how long you need to be on warfarin. How to Take Warfarin (Administration & Compliance) How Much Do I Take & When Do I Take It? The dose of warfarin is adjusted to your individual needs. The proper dose is determined by a blood test called the INR. The INR reflects how much warfarin is in your bloodstream. Your healthcare provider will tell you what INR level is best for you. It is important to have your blood tested regularly. Your response to warfarin may change with time and the dose may need to be adjusted from time to time. Your healthcare provider (physician, nurse practitioner, or pharmacist) will adjust the dose for you. Please use a Warfarin Dosing Diary" such as the one located in this booklet to help you keep track of your Warfarin dosage. DO NOT ADJUST THE DOSE ON YOUR OWN. Take your warfarin at the same time every day. We recommend that you take it in the afternoon or evening so that your dose can be adjusted on the day of your clinic appointment. SDMED0080 Revised 6/14 Find a Doctor: (888) Patient Education Library:

2 What If I Miss a Dose? If you miss one dose, do not take 2 doses the next evening. Continue taking your normal dose as prescribed. Mark on your calendar the day you missed a dose; tell your healthcare provider the next time you see him or her. If you missed two doses, please contact your healthcare provider for further instructions. Dietary Advice Vitamin K is part of the process that forms blood clots. The amount of vitamin K in your diet may change your response to warfarin. You do not need to avoid foods that contain vitamin K, but you should eat a consistent amount of these foods. Note how much and how often you eat foods high in vitamin K. Vitamin K is found in some vegetables and some fruits. Foods that are highest in vitamin K are dark green leafy vegetables. Your doctor will adjust your warfarin dose based on the amount of vitamin K you eat in your diet. Avoid drastic changes in your diet. Ask your healthcare provider before changing dietary habits. Foods High in Vitamin K If you normally eat more than one serving a day of foods high in Vitamin K, inform your doctor of your typical intake so that your medication may be adjusted. Foods High in Vitamin K Broccoli (cooked) Brussels sprouts (Frozen, boiled) Collard greens (Fresh, boiled) Kale (Fresh, boiled) Mustard greens (Fresh, boiled) Parsley (raw) Spinach (Fresh, boiled) Spinach (cooked or raw) Swiss Chard (Fresh, boiled) Turnip greens (Frozen, boiled) 2

3 Foods Lower in Vitamin K The following foods are lower in vitamin K and can be eaten as desired: Beans and lentils Other leafy greens iceberg lettuce, butterhead lettuce, green leaf lettuce, cabbage, bok choy Vegetables celery, carrots, tomatoes, cucumbers, peppers, peas, asparagus, okra Fruits/berries pears, plums, kiwis, blackberries, blueberries Meat, fish, poultry and eggs Cereals and grains Dairy products including milk, cheese, and yogurt Alcohol Drinking alcohol (beer, wine, and liquor) will decrease your clotting ability. It is best to avoid alcohol or limit the amount to less than one serving per day. (example: 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of distilled spirits) Discuss your use of alcohol with your health care provider. Additional Dietary Information The Coumadin Cookbook: A Guide to Health Meals When Taking Coumadin by Rene Desmarais, Greg Golden, and Gail Beynon, Important information to know when you are taking: Warfarin (Coumadin) and Vitamin K, National Institutes of Health Clinical Center Drug-Nutrient Interaction Task Force, Bethesda, MD, 9/5/ USDA National Nutrient Database for Standard Reference. Release 26. Nutrient list for Vitamin K &nutrient2=&nutrient3=&subset=0&fg=&sort=f&measureby=m Warfarin Side Effects, Drug Reactions, and Interactions Side Effects Bleeding is the primary side effect of warfarin. The risk of bleeding is greater when your INR is higher than the desired level. At these times, you may bruise more easily, bleed from your nose or gums, or notice blood in your urine or stool. 3

4 Adverse Drug Interactions There is a potential for interactions between warfarin and prescription medications, which may have an influence on your INR. Always check with your healthcare provider before taking any new medications or stopping any medications you have been taking, including non-prescription medications or herbal supplements. Avoid taking aspirin unless prescribed by your healthcare provider. Use acetaminophen for pain. You should always keep an up-to-date list of all of your medications with you and bring it to clinic. Herbal Supplements Many over-the-counter herbal remedies have anticoagulant properties that may affect your blood clotting ability. Because little is known of their function, discuss with your provider before using any herbal supplement. Vitamins Taking high doses of some vitamins may interfere with the clotting actions of Warfarin. Inform your doctor of the vitamins and doses you currently take. Follow-up & Monitoring When Will I Have To Take An INR Test and what things can affect my INR? Schedule an anticoagulation (INR) follow-up appointment to be within 7 days of discharge (or as directed by your provider). INR tests are repeated frequently during early treatment to find the proper dosage for you. Once the dosage has been determined, the frequency of testing will decrease, but you should expect to have your blood tested at least monthly. Several things may affect your INR. Some of these things include diet, sickness and medications. Please report any changes in these factors to your healthcare provider. Inform All Healthcare Providers are Aware you take Warfarin Inform your healthcare provider if you plan to have surgery or medical procedures, such as a colonoscopy. You must avoid becoming pregnant while taking warfarin since it has been associated with birth defects. Use appropriate contraception if there is a risk of becoming pregnant. Please discuss with your provider if you are thinking about becoming pregnant. Keep a record of all the medications that you take, both prescription and non-prescription. Bring your medication list with you when you come to the clinic. Carry an I am taking Warfarin card with you to alert healthcare providers that you are taking warfarin. Wear medical alert jewelry that lets others know that you are taking warfarin. Go to or call to get information on how to order a bracelet. 4

5 Avoid bleeding by preventing falls & injuries Avoid activities or sports that may result in serious falls or other injuries. Wear slippers or shoes with nonskid soles Remove throw rugs and clutter Rearrange furniture and electrical cords to keep them out of walking paths. Keep stairways, porches, and outside walkways well lit. Use night-lights in hallways and bathrooms Be extra careful when you work with sharp tools or knives When to call for help Call 911 anytime you think you need emergency care. Call your doctor now or seek immediate medical care if: You have any abnormal bleeding such as: Nosebleeds that do not stop Vaginal bleeding that is different (heavier, more frequent, at a different time of the month) than usual Bloody or black stools, or rectal bleeding Bloody or pink urine If you develop a bruise that is located near a joint, especially if it interferes with movement. Colors of Tablets: 1 mg Pink 2 mg Lavender 2.5 mg Green 3 mg Tan 5 mg Peach 6 mg Teal 7.5 mg Yellow 10 mg White 4 mg Blue 5

6 Warfarin Dosing Diary Target INR: Warfarin strength: mg INR (date): Sun Mon Tues Wed Thurs Fri Sat Warfarin strength: mg INR (date): Sun Mon Tues Wed Thurs Fri Sat Warfarin strength: mg INR (date): Sun Mon Tues Wed Thurs Fri Sat Warfarin strength: mg INR (date): Sun Mon Tues Wed Thurs Fri Sat 6

7 I am taking WARFARIN, an anticoagulant that prevents blood clots from forming. Name: Address: Birthdate: Weight: Blood type: Other medications: Reason for warfarin: Target INR: In case of emergency, please notify: Doctor s name: Doctor s phone number: Nearest Emergency Room phone number: 7

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SAMPLE ONLY. Your Child s Health. A Pediatric Patient s Guide to Using Warfarin. Please order from Documents, Media and Mail: 415/

SAMPLE ONLY. Your Child s Health. A Pediatric Patient s Guide to Using Warfarin. Please order from Documents, Media and Mail: 415/ Physician Referral Service: 888/689-UCSF Your Child s Health A Pediatric Patient s Guide to Using Warfarin Warfarin (WAR-far-in) Brand Name: Coumadin The purpose of this brochure is to inform you about