High INR. What You Should Know If You Take Coumadin or Warfarin. Why Do You Take Warfarin? What is Warfarin (Coumadin )?

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1 Overview What You Should Know If You Take Coumadin or Warfarin Jennifer Taylor, PharmD, CACP Holy Family Anticoagulation Clinic What is Warfarin (Coumadin )? Monitoring of Warfarin Signs and Symptoms of Bleeding Signs and Symptoms of Blood Clots When To Call Your Doctor or Emergency Effects of Prescribed Medicine, Vitamins, Herbals and Over-The The-Counter Medicine Effects of Diet and Alcohol Patient ID Card and Your Medicine List Holy Family Anticoagulation Clinic What is Warfarin (Coumadin )? Warfarin is an anticoagulant Anti- Against Coagulant- Clots Warfarin prevents blood clots from forming easily in the body Why Do You Take Warfarin? Atrial Fibrillation- irregular heart beat Heart Valve Replacement Blood Clots in the veins of the body Arms, Legs, Lungs Prevention Heart Attack Genetic Conditions Promoting Blood Clots Stroke- blood clot to the brain Know Why You Take Warfarin Monitoring of Warfarin INR (International Normalized Ratio) Know your goal Have your blood checked at least monthly Have your blood checked when you change medicines Have your blood checked when you are sick Have your blood checked when you have big changes in your diet Have your blood checked if you are bleeding High INR High INR= Increased Bleeding= Thin Blood 1

2 Warfarin Side Effects: Bleeding Symptoms EYES NOSEBLEED GUMS COUGH or SPIT or VOMIT Coffee Grounds Vomit Red or Rusty or Dark Brown URINE Black, Bloody, Tar Looking STOOL BRUISES Cuts that BLEED CALL YOUR DOCTOR or ANTICOAGULATION PROVIDER Low INR Low INR= Clotting= Thick blood BLOOD CLOT SIGNS in Legs, Arms or Lungs Pain or Swelling in lower leg or foot Warm or red lump in leg Unusual shortness of breath Unusual chest or rib pain while breathing Coughing Blood CALL YOUR DOCTOR or ANTICOAGULATION PROVIDER OR GO TO THE EMERGENCY ROOM A stroke is a brain attack A stroke is what happens when the blood supply to part of the brain is cut off. Blood carries essential nutrients and oxygen to the brain. Without a blood supply, brain cells can be damaged or destroyed and won t be able to do their job. STROKE SIGNS (Blood Clot in the Brain) Face Sudden weakness or numbness in face, especially on one side Arm weakness Especially on one side Speech difficulty TELL EMERGENCY CALL 911 2

3 STROKE SYMPTOMS Every Second Counts! Sudden trouble swallowing Sudden double, blurred or loss of sight Sudden SEVERE headache Unexplained sudden dizziness, loss of coordination, falling Falls or Head Injury DON T T WAIT, CALL 911 FALLS and HEAD INJURY What You Eat Affects Warfarin Risk of bleeding inside the body or brain Bleeding in the brain can be life- threatening PREVENTION! See your doctor or Emergency Room Vitamin K Containing Foods Vitamin K In Your Diet More Vitamin K= More Coumadin Less Vitamin K = Less Coumadin Keep Vitamin K intake CONSISTENT 3

4 Warfarin and Vitamin K in My Diet Can I eat Vitamin K containing foods? YES Foods to Avoid with Warfarin Should I eat very large servings of Vitamin K containing foods occasionally? NO Should I vary the amount of Vitamin K foods I eat? NO Should I avoid Vitamin K containing foods? NO Should I be consistent in the amount of Vitamin K containing foods I eat each week? YES Beverages to Avoid with Warfarin Alcohol With Warfarin Alcohol, in large amounts, increases bleeding risks when taken with warfarin Alcohol can increase INR or make blood thinner Limit Alcohol intake to no more than 1-21 drinks in a day OR AVOID 1 Drink = 1 beer OR 1 glass wine OR 1 shot liquor Herbals and Supplements Vitamins and Herbs and Supplements AVOID or Take With Caution Ginseng (panax) Ginger pills Garlic pills Gingko Flax seed Echinacea Chamomile Melatonin Saw Palmetto Papain Dan shen Dong quai Alfalfa Anise Arnica Artemesia Coenzyme Q 10 Fish Oil Omega 3 Oil Vitamin K Multivitamins w/ vit K Sweet Clover Horse Chestnut Aloe Gel Black Cohosh Fenugreek Licorice Parsley pills Passionflower Prickley ash Quassia Algae St John s s Wort Cassio Clover Feverflew Tumaric Meadowsweet Poplar Willow bark Sweet woodruff Tonka beans Celery Celery pills 4

5 Over-The The-Counter Medicine Over-The The-Counter Medicines to AVOID Many Contain Aspirin Many Contain Herbs that Interact Many Contain NSAIDS (non-steroidal anti- inflammatory drugs) Use Over-The The-Counter Medicine With Caution Verify with Doctor or Anticoagulation Provider before taking any over-the the- counter medicine Food Supplements Limit OR Take Regularly V-8 8 Juice Ensure Products Boost Products Protein Supplements Soy Products Carnation Instant Breakfast Nutrition or Sport Bars Viactive Calcium Chews Multivitamins containing vitamin K Nu Basics Products Notify Medical Care Wallet Card Identification ID Bracelet Full list of all medicines you take Providence Holy Family Anticoagulation Clinic 5901 N Lidgerwood #128 Spokane, WA Fingerstick INR with immediate results Pharmacists specialized in anticoagulants Warfarin dose adjusted at time of visit Individualized Education Physician informed of your progress Patient Self-Testing at home available for eligible patients Home INR Monitor Patients qualify for Home INR Testing Insurance coverage verified Training in office- patient or caregiver Patient or caregiver tests INR weekly in the home Patient calls results to HFH for dosing and evaluation Patient visits clinic as needed and for other anticoagulation needs 5

6 Summary Check INR regularly or when changes Watch for bleeding or blood clot symptoms and CALL if occur Eat consistent amounts of foods high in vitamin K Avoid herbals and over-the the-counter medicine that interact with warfarin Limit or avoid Alcohol Carry identification and a medicine list Consider Holy Family Anticoagulation Clinic for anticoagulation care Questions? 6