The most important thing to remember when
you’re taking Coumadin is to not miss a dose. That’s very important. The most important thing about being on
warfarin user is that you have to be proactive. You have to ask questions and you have
to have the answers yourself. It’s a little scary but you have to know
the dos and don’ts and follow directions. Hi there.
You’re watching this video because you’re currently taking the drug called warfarin. Warfarin is the generic name
for Coumadin and Jantoven. If you’re at risks of getting a blood clot
or if you already had one, this powerful drug can save your life. Although warfarin is safe and effective,
it has to be properly monitored. This video will show you how to care
for yourself while you’re taking warfarin. Alright, what we’ll gonna do is we’re
actually gonna a finger test today. Alright.
Some people referred to warfarin as a blood thinner although it really isn’t.
Warfarin is actually what we call an anticoagulant which means it prevents
harmful blood clots from developing in your body.
Sometimes people have harmful blood clots that we want to prevent from getting bigger
and so we put them on warfarin. Other people we put on warfarin because
we’re trying to prevent harmful blood clots from developing. Well, blood supposed to clot but you don’t
want it to clot in your blood stream. If it does clot on your blood stream and
then it obstructs the flow of blood to your organs. People take warfarin for different reasons.
You may be on it because you’ve had a heart attack, stroke, or a blood clot also
called a deep vein thrombosis or DVT or an irregular heartbeat.
If you have a heart valve replacement, warfarin may also prevent a clot
from developing around an artificial heart valve. Some people have to take warfarin for the
rest of their lives while others maybe on it for only a few months or years. The most important and easy way for me to
remember to not miss dose everyday is that I leave my prescription medication by my keys.
That way, when I’m going out the door, I’ll see the bottle and I won’t
forget to take the medicine. You take warfarin once a day
with or without food. It’s best to take it at the
same time every day. Some people use a calendar or a pillbox to
help them remember to take their warfarin. If you forgot to take your pill, don’t take
an extra one to catch up, that could increase your risk for bleeding.
What we’d like you to do is just take your regular scheduled dose the following day
and then notify your provider that you’ve missed your dose.
At the same token, if you take an extra dose by mistake just call them again and
let them know that you’ve taken an extra dose of your warfarin. Warfarin comes in many shapes depending
on the company that made it. The tablets maybe round, square, or oval. The tablets are color-coded based on the
strength or how much medicine it contains. Strength or the dose is measured
in milligrams and each tablet has a different color. For example, all 5-mg tablets are peach
whether they are generic or a name brand. The amount of medicine needed to prevent
blood clots varies from person to person and may chance overtime. So, check your tablet color each time you
get your prescription refilled and if it’s a different color than you normally get,
you should check with your health care provider or clinic as you may be getting
a different strength than you normally receive. The only way to know if you’re taking
the correct dose and if your warfarin is working is to get a blood test done called
the international normalized ratio or INR for short.
You can’t tell if it’s working by how you feel so it’s really important to have your
blood test on a regular interval at least once every four weeks.
Okay, now you’ll gonna feel alright. The INR is used to measure how much time
it takes for your blood to clot. The results will tell your provider how
much medicine you need and if the dose needs to be changed.
You should be tested within one week starting the medicine or within one
week of leaving the hospital. And now, our machine is going
to calculate your INR. The INR is done by taking blood from
your fingertip or from a blood test. The blood is put into the machine and
the results show up as in number. Asked your provider what’s
your INR range should be. And your number is 2.5.
That’s very good. Your goal is 2 to 3, so your – Getting
the right dose of warfarin can be very tricky and may require some adjustments
to get is just right. It took between six weeks and two months
to determine the right combination of warfarin by the provider.
I go back now about once a month to have my blood checked.
When you start warfarin it’s important for you to range for a clinic or a medical provider
to test your INR and to manage your dosing.
So, if you’re taking too much warfarin that will cause your INR number to be too
high and that means that you are at higher risks for having bleeding problems.
If you’re taking too little warfarin, your INR number will be too low and so warfarin
won’t protect you from developing another blood clot.
You should tell everyone that you’re taking warfarin.
In any healthcare setting, make sure that your doctor, your dentist, your nurse,
anybody who’s writing a prescription knows that you’re taking warfarin because of the
strong potential for reactions between new drugs and the anticoagulant medication. When I get the gout, I have to call
the Coumadin Clinic and then let them know that I am on another prescription drug that
of course is going to add because my levels will even go high or low.
Warfarin can increase your risks of bleeding by itself.
There are certain over-the-counter medicines that can also increase your
risks of bleeding while you’re taking warfarin as well.
For example, aspirin is an ingredient in several cough and cold preparations.
It’s always best to read the label of all over-the-counter medicines. Warfarin also interacts with a number of
prescription medications like antibiotics as well as with herbal products,
nutritional supplements, and vitamin products containing vitamin K.
It is very important to tell the healthcare provider that’s monitoring
your warfarin if you start a new medicine, stop one of your medicines, or even if you
change the dose of one of your medicines. Warfarin can interact with multiple medicines
out there and it’s important because it can affect your INR.
If you inform your healthcare provider, they would be able to check your INR sooner
and possibly adjust your dose if it’s needed.
I always check with my doctor to make sure that whatever medication is proposed,
it doesn’t conflict with warfarin. For example, I’m on two different types
of medication for my high blood pressure and I made sure that there wasn’t
any particular problem with that and I will always do that.
Talking to your pharmacist is another way of protecting yourself from dangerous drug
interactions while you are taking warfarin. Tell your pharmacist that you’re taking
warfarin and give that person a list of all the over-the-counter and prescription
medicines you take. I learned finally that I have to
be consistent in my intake of food particularly the K vitamin. Some food especially dark green-leafy
vegetables contain high amounts of vitamin K. Vitamin K helps the blood to clot which
means it works against the warfarin and could lower your INR. Spinach, broccoli, cabbage, kale, Brussels
sprouts, and collards are all high in vitamin K and may affect how
warfarin works in your body. In addition to dark green-leafy vegetables,
vitamin K is also added to some weight loss products and nutritional
supplements such as Slim-Fast, Ensure, Boost, and instant breakfast. To be safe, be sure you read labels carefully
so you know which products to avoid. The dose of warfarin is based on how much
vitamin K you’ve normally have in your diet. Most people think you can’t have
vitamin K, but you can. What we do is when you start warfarin
we’re gonna asked you in average week how many times you have vitamin K with your food. Then, what we will do is dose your
warfarin to your existing diet. It is important for patients who are
taking warfarin to try to eat the same amount of vitamin K containing foods each week. If they eat too much vitamin K during
any week, it will make their INR go down and they won’t be as protected as they should be.
If they ate too little vitamin K during a week, then their INR may go up and they
may be at high risks for bleeding. So, trying to keep the diet steady from
week to week is very important. When travelling, it’s important to try to
keep your diet as steady as possible as close to your diet at home as possible so
that you keep your INR in the normal range where it usually is when you’re at home.
If you get sick while taking warfarin, it’s a good idea to contact your provider
to make sure that she should then get an INR test done sooner because sometimes
when you get sick your INR can go up. As far as my diet goes, I’m always
afraid of making mistake. For example, am I eating one or too many
spinach or broccoli, will that make a difference? I was fortunate that my provider gave me
a copy of a list of the items that I have to watch for, the ones who
will high or low with vitamin K. What I had do worry about when I first
started was the size of the portion. What was the serving and how do I measure? So, there are a couple of ways to simplify life.
One way, to understand the serving size of a vegetable for cooked is one-half cup
and then for raw vegetable is about one cup. So, one way to visualize this is that
a clenched fist equals to about one cup and if you open up the clenched fist, it gives
you about half a cup of cooked vegetable serving size. It is also important to measure your
intake of serving beverages such as cranberry and grapefruit juice and alcohol
as they can increase your risks of bleeding. A serving size for a fruit juice
is about 4 ounces or half a cup. You can again – for you to estimate how
much that is visually, you can use your fist and kind of gauge it.
It’s about 4 ounces or half a cup, correct? And also, another way to use is that you
can measure it out for the first time. How much that is? It’s about 4
ounces and you can use your regular household cup to kind of
pour in to help you gauge again. It’s important that you are consistent.
Consistency is the important key. If your INR is too high, then sometimes
you could bleed internally and the places that you might bleed could be inside your
head in which case the symptoms that you’d experience would be headache or some other
neurologic thing, a little bit like having a stroke. If you developed a blood clot, you may
notice a sudden increase in swelling, consistent pain, redness, or
warm in your arm or leg. If you have a history of venous thrombosis
and on warfarin, the thing we feel is a condition called pulmonary embolism. Embolism is when a blood clot that forms
in one part of your body, floats away and then is propelled in the blood
stream into another part. If you feel pain in the chest, often a
pain that’s made worse by breathing and you’re suddenly more short of breath,
then that could be a dangerous warning signs and should be a reason to call your doctor
or heads to the emergency room. Go to the emergency department if you
have other symptoms that made your bleeding such as bright red blood in the toilet after
you go to the bathroom, smoky pink or red-colored urine, black and sticky
stools like tar that may also smell unusually bad, a sudden and extremely
painful headache worse than any headache in your life, or if you briefly blackout,
can’t move, have trouble talking, or become very weak especially if you’re
weak on only one side of your face or body, that could be a stroke. Besides the normal signs of clotting
and bleeding, there are things you can do to reduce the possibility. The first is to use a soft bristle toothbrush. Secondly, I change from using a regular
razor to an electric razor. So, make sure that you try to not
be clumsy, try not to fall. If you gonna be outside, be very careful
of the tools that you’re using and make sure that you’re not cutting yourself,
keep sharp objects away from yourselves. Warfarin does make you bruise more easily.
If you do bump into something, hold pressure or put ice on the site for 2 to 5 minutes.
If the bruise is bigger than 3 inches across or about the length of your finger
or if it keeps getting bigger, go to the nearest emergency department and
tell them you take warfarin. Anyone on warfarin runs the risks of bleeding.
If you get hurt and start to bleed, you need to know that things you can
handle yourself and when you should go to the emergency department. The most important thing to remember is
that you do get a kind of apply pressure with your thumb or into the cut
for about 2 to 5 minutes. If it doesn’t stop bleeding, you need to
contact your doctor as well as go to the emergency room.
Some people do have trouble with nosebleeds. A humidifier, a saline nasal spray or gel,
may help keep the nose moist and prevent bleeding. If you do get a nosebleed don’t hold your
head back, instead hold your head in a normal upright position, pinched your
nose together just below the bony part and squeeze tightly for 2 to 5 minutes, breath through your mouth until the bleeding stops. If okay with your provider, you could try
a nasal decongestant spray to help stop the bleeding, but if the bleeding doesn’t
stop after 20 to 30 minutes, we recommend you go straight to the emergency department
and tell them that you’re taking warfarin. I do worry about heavy bleeding during my cycle.
I tend to have a very heavy cycle and I worry that the medicine may make
my bleeding even worse. If you still have heavy menstrual cycles,
you don’t need to be concerned about your monthly bleeding as long as you’re getting
your INR checked on a regular basis. Your periods may be a little heavier than
normal, but if you have any questions or concern be sure to ask your medical provider. So, while warfarin is safe for most
patients, pregnant patients should not take warfarin because it can cause birth defects. In addition, women who are in childbearing
age should consider taking contraceptive agents so that they not become pregnant
while taking warfarin. There is a lot to think about when you’re
on warfarin but it’s really not so hard to manage it safely. Remember to check your INR regularly, inform
your provider at any changes in your medicine, eat a consistent amount of
foods high in vitamin K, know how to treat minor bleeding, when to go for help and be
sure to talk to your healthcare provider if you have any questions. For more information, go
to [email protected] or www.hopkinsmedicine.org/hematology/anticoagulation
or call (410) 502-8641.