Warfarin Users Guide 011 967 1881 / 011 967 1880 / 011 967 1883 / 011 967 1885 / 087 195 0179 / 010 100 3966 / 010 100 8973 / 073 197 3756 / 083 250 5484 / 011 967 1881 / 011 967 1880 / 011 967 1883 / 011 967 1885 / 087 195 0179 / 010 100 3966 / 010 100 8973 / 073 197 3756 / 083 250 5484 / 011 967 1881 / 011 967 1880 / 011 967 1883 / 011 967 1885 / 087 195 0179 / 010 100 3966 /
Warfarin is an anticoagulant (blood thinner). Warfarin reduces the formation of blood clots. Warfarin is used to treat or prevent blood clots in veins or arteries, which can reduce the risk of stroke, heart attack, or other serious conditions. In South Africa there are 2 Brands for Warfarin, namely MAREVAN and COUMADIN. How does Wafarin work and how much should I use? In Normal circumstances, the body s bleeding- and clotting activities are balanced. In some cases this balance changes and it increases the risk of developing bloodclots. Wafarin interferes with Liver s ability to use Vitamin K. Blocking vitamin K prevents blood clots forming so easily by increasing the time it takes to make fibrin. It usually takes two or three days for these medicines to work fully. Every person s metabolism is different, and each person will react differently to the Wafarin. Your Doctor will prescribe the best dose of Wafarin based on your Blood Results. What is Prothrombin Time or INR? Prothrombin time (PT) is a blood test that measures how long it takes blood to clot. A prothrombin time test can be used to check for bleeding problems. PT is also used to check whether medicine to prevent blood clots is working. A PT test may also be called an INR test. INR (international normalized ratio) stands for a way of standardizing the results of prothrombin time tests, no matter the testing method. It lets your doctor understand results in the same way even when they come from different labs and different test methods. In some labs, only the INR is reported and the PT is not reported. Your Doctor will inform you on how regularly you will have to test your blood for your INR Determination. As soon as your Warfarin levels have stabilized, you will only have to have the test done every 3 4 weeks. Your dose of Warfarin could change depending on the results of your INR test. 1
How do I take Warfarin? Warfarin is normally taken only once a day, with or without food. Some Doctors prefer that their patients take the Warfarin at night. After every blood test, the Laboratory will contact you with the instructions on how to take your medication. Any change in dose should be noted for your records. Included in this brochure is an example of how the Dosage should be written down. This will remind you on the correct dosage for the day. When should Warfarin be taken? The dose should be taken exactly the way your Doctor requested, and doses should not be missed. In the case where you have forgotten to take your medication, and then remembered within a couple of hours, the medication should still be taken. If you have forgotten to take your medication, and only remembered the next day, only take the dose for that day. Double doses should never be taken. In the event that you have skipped more than one dose, please contact your Doctor for advice. Why is my Diet important? Vitamin K and Warfarin is known to work against each other. It is thus important to be aware that a change in diet, can have an effect on the Warfarin activity on the Liver. Vitamin K is essential for a healthy diet; do not try to eliminate it from your diet entirely. In reality, the recommended amount of Vitamin K is the same for people that take Warfarin and that not on treatment. Try to regulate your Vitamin K intake. You do not have to eat exactly the same food every day! A Diet with all the different food categories is important. Remember Vitamin K is necessary for a balanced diet, and food that contain Vitamin K should be included. Food that contain loads of Vitamin K includes: broccoli, Brussel sprouts and leafy green vegetables like Spinach and Cabbage. Golden Rule: The greener the vegetable, the Higher the Vitamin K content. Canola and Soya- oil also has a high Vitamin K content. Most fruits, meats, dairy- and grain products have Low Vitamin K content. Nutrient supplements such as Sustagen and Resource, that have been recommended by your Doctor for extra calories or supplements is actually low in Vitamin K. 2
Vitamin K The list that follows is not a list of foods that should be avoided, and it is also not a complete list of all the Food Types that contain Vitamin K. This will only give you an indication of foods with High and Moderate Vitamin K content. This is only a guideline to follow a balanced diet. Food with a Low Vitamin K Content Food with Moderate Vitamin K Content Food with a High Vitamin K Content Alfalfa Asperagus Broccoli Green Beans Avocado Brussel Sprouts Carrots and Red Cabbage Cauliflower (Cooked) Cauliflower Celery, Wheat, Potato Peas Chicory Bread, Grains Iceberg Lettuce Gourmet Lettuce Rice Dill Parsley Fruits and Juices* Beans Beetroot (Cooked) Cheddar Cheese, Milk Blue Cheese Spinach (raw/cooked) Eggs, Butter Margarine Mayonnaise Sunflower- and Olive oil Canola- and Soya oil Sesame oil Fish, Red Meat, Pork and Chicken Abalone Liver * Cranberry Juice increases bleeding in Warfarin Patients. What about other Medication? There are a lot of medications that can influence the anticoagulation properties of Warfarin. These medications include Prescription and Over the Counter drugs. How to decrease the risk: Communicate to your Doctor or Pharmacist before any medication is started or stopped. Inform the Pharmacist that you are on Warfarin before you buy over the counter drugs. Ask your Pharmacist before you buy any vitamins, herbs or natural medication. When you go to an alternative Doctor or Dentist, ensure that they know you are on Warfarin. Wear a MedicAlert bracelet. The following tables indicate some of the most common drugs and other products that interact with Warfarin. 3
Warfarin and Other Medications There are a lot more medications that can interact with Warfarin that is not included here. These are examples of medications and complementary products that can increase the coagulation risk. It is not a complete list Please contact your Doctor or Pharmacist should you have any concerns. Type of Medication Prescription Complementary Products Example Anti-Epileptic agents eg. Carbamazepine (Tegretol ) and phenytoin (Dilantin ) Anti-Thyroid eg. Carbimazole (Neo-Mercazole ) and Propylthiouracil Ginseng Green Tea St. John s Wort Vitamin K (in some Multivitamins) These are examples of Medication and Complementary Products that can increase the bleeding risk. It is not a complete list Please contact your Doctor or Pharmacist should you have any concerns. Type of Medication Prescription OTC Medication Vitamins, Herbs and Complementary Products Example Antibiotics eg. Cotrimoxazole (Bactrim ) and erythromycin (Eryc ) Anti-Inflammatories eg. Indomethacin (Indocid ) and celecoxib (Celebrex ) Ulcers and Reflux Medication eg. Omeprazole (Losec ) and cimetidine (Tagamet ) Hart and Cholesterol Medication eg. Amiodarone (Cordarone ) and simvastatin (Zocor ) Asprin and Painkillers Cough and Flu Medicine Oral anti-fungal eg. Miconazole (Daktarin oral gel ) and fluconazole (Diflucan ) Vitamin E Co-Enzyme Q10 Garlic Supplements Ginger Supplements Ginkgo Biloba Glucosamine 4
Other Factors that can influence your Warfarin and INR Alcohol The best would be to avoid alcohol completely. In the case that you do use alcohol, your daily intake should be reduced to 1 or 2 standard drinks per day, with 2 alcohol free days a week. One Standard Drink is equal to: A small glass of wine (100 ml) One cap alcohol (30 ml) One normal strength beer (285 ml) Alcohol in excess can influence your Liver Function, which would influence the Warfarin interaction. Alcohol also irritates the stomach lining, that could cause a stomach bleed. Illness Any new illness in the line of: Diarrhea or nausea Fever or Infection Loss of appetite Jaundice Medicines used to treat the illness Please contact your Doctor should you be sick with Fever, Flu or Infection Lifestyle Any lifestyle changes that should be communicated to your Doctor include: Change in intensity of Exercise Change in diet do you fast often? Traveling long distances? ensure you always have enough Warfarin at hand. Warfarin should be avoided during pregnancy, it could influence your unborn baby during early pregnancy 5
Signs and Symptoms of unusual bleeding When your INR is too high, you may experience unusual bleeding. The signs include: Serious Bruising that does not heal Any bleeding that takes a while to stop Unexplained bleeding or bruising Menstrual Bleeding that is heavier than usual Red or Dark Colored Urine Red or Black Stools Coughing Blood Dark Colored Vomit Serious Headaches or Lightheadedness Weakness or Apathy Unusual Pain or Swelling Should you have any of the above symptoms, and you are worried, please contact your Doctor. Should your Doctor not be available, go to your nearest Hospital or Emergency Department. Live Safely with Warfarin You can continue with your daily routine, but it would be advisable to avoid any contact sport. Small cuts and scrapes should be cleaned and covered with a band aid. Larger cuts should be covered with a Bandage and pressure should be applied to prevent further bleeding. Your Doctor should be contacted immediately. Around the House: Use a Bath mat to prevent slipping Use a soft bristled toothbrush Use an electrical razor Use gloves while working in the garden Be careful around animals Wear slip Free Shoes to prevent falling. Be careful with kitchen utensils eg. Knives. 6
INR Monitoring Name: Referring Doctor: Warfarin: Tablet Strength: Preferred INR Range: Preferred Warfarin Dosage Date INR Mon Tue Wed Thu Fri Sat Sun Next Appointment 7
INR Monitoring Name: Referring Doctor: Warfarin: Tablet Strength: Preferred INR Range: Preferred Warfarin Dosage Date INR Mon Tue Wed Thu Fri Sat Sun Next Appointment 8
INR Monitoring Name: Referring Doctor: Warfarin: Tablet Strength: Preferred INR Range: Preferred Warfarin Dosage Date INR Mon Tue Wed Thu Fri Sat Sun Next Appointment 9
INR Monitoring Name: Referring Doctor: Warfarin: Tablet Strength: Preferred INR Range: Preferred Warfarin Dosage Date INR Mon Tue Wed Thu Fri Sat Sun Next Appointment 10
INR Monitoring Name: Referring Doctor: Warfarin: Tablet Strength: Preferred INR Range: Preferred Warfarin Dosage Date INR Mon Tue Wed Thu Fri Sat Sun Next Appointment 11
INR Monitoring Name: Referring Doctor: Warfarin: Tablet Strength: Preferred INR Range: Preferred Warfarin Dosage Date INR Mon Tue Wed Thu Fri Sat Sun Next Appointment 12
INR Monitoring Name: Referring Doctor: Warfarin: Tablet Strength: Preferred INR Range: Preferred Warfarin Dosage Date INR Mon Tue Wed Thu Fri Sat Sun Next Appointment 13
INR Monitoring Name: Referring Doctor: Warfarin: Tablet Strength: Preferred INR Range: Preferred Warfarin Dosage Date INR Mon Tue Wed Thu Fri Sat Sun Next Appointment 14
INR Monitoring Name: Referring Doctor: Warfarin: Tablet Strength: Preferred INR Range: Preferred Warfarin Dosage Date INR Mon Tue Wed Thu Fri Sat Sun Next Appointment 15
INR Monitoring Name: Referring Doctor: Warfarin: Tablet Strength: Preferred INR Range: Preferred Warfarin Dosage Date INR Mon Tue Wed Thu Fri Sat Sun Next Appointment 16
Notes 17
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Contact Details Main Laboratory 131 Glen Gory Road Tel: 011 967 1881 Norton Home Estates Fax: 086 243 7588 Benoni Email: info@pathlabs.co.za 1501 Depots Bedfordview Suite 5 West Wing Bedford Gardens Hospital Leicester Road Bedfordview 2007 Tel: 011 622 5107 Umhlanga Shop G4, The Square 250 Umhlanga Rocks Drive La Lucia 4051 Tel: 031 566 4059 Email: umhanga@pathlabs.co.za Website: www.pathlabs.co.za 19