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 acclinic@jhmi.edu or
www.hopkinsmedicine.org/hematology/anticoagulation or call (410) 502-8641.