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1 Warfarin Warfarin is a useful medicine that helps many patients and has been used since the 1950s. It can be dangerous when not used correctly or without proper medical attention. This leaflet will help you take your warfarin correctly and safely. It answers common questions patients ask about warfarin but if you have any other questions please ask your nurse or doctor. By understanding warfarin you can help make your treatment safer and more effective. What is warfarin? Warfarin is an oral anticoagulant (blood-thinner) medication that is used to treat or prevent blood clots forming in your body Warfarin tablets come in different strengths, for example 0.5mg (white), 1 mg (brown), 3 mg (blue) and 5 mg (pink) Blood tests are needed to monitor the effect of warfarin Bleeding is the most common and potentially most serious side effect of warfarin Infrequently rashes, nausea (feeling sick), vomiting, diarrhoea and hair thinning can occur. If you have any of these symptoms please discuss with your doctor The length of time you will need to take warfarin depends on the condition being treated

2 Why do I need to take warfarin? The two most common reasons for warfarin treatment are: To treat blood clots in the legs (deep vein thrombosis or DVT) or in the lungs (pulmonary embolism or PE). Treatment normally last for three to six months, but may be for longer. To prevent blood clots in the heart which can cause a stroke in conditions such as atrial fibrillation (AF) or metallic valve replacements (MVR) where treatment is usually long term. How is warfarin monitored and adjusted? A blood test called the INR (International Normalised Ratio) is used to monitor warfarin. In a person not taking warfarin the INR is 1. Your INR treatment will depend on your condition and usually ranges from, 2.0 and 3.0. The warfarin dose needed to achieve this INR range varies from person to person. It takes four to five days to reach this target INR. In the first couple of weeks, you will need regular blood tests. Once you achieve this, the blood tests will become less regular and happen every few weeks. The dose of warfarin may be changed based on the INR result. After each test, you will be told what dose to take each day and when to have your next blood test. This will be written down in your Anticoagulant Treatment Record (yellow book), which contains your INR results and warfarin dose. You should always bring your yellow book to the anticoagulation clinic. 2

3 Where do I get my tablets from? The clinic will give you a supply a tablets at the start of your treatment Further tablets should be obtained from your GP. If you show your GP your yellow book with a recent INR result, you will be given a prescription How can I take warfarin safely? Take your warfarin as prescribed, keep your clinic appointments and make dose changes as advised We recommend you take your daily warfrain before, with or after your evening meal Make sure you always have enough tablets. Your GP will provide you with repeat prescriptions Missed doses: You should avoid missing a dose. If you do, do not take a double dose to make up for it. If you take your warfarin with your evening meal and miss a dose, the missed dose can be taken anytime before bedtime. Pregnancy: Warfarin can affect a baby s development and can lead to malformations, especially in the first 12 weeks of pregnancy. Appropriate contraceptive measures should be used by a woman of childbearing age whilst on warfarin. If you plan to become pregnant or think you are pregnant, please talk to your doctor to discuss any concerns you may have. For emergencies: Carry identification that states you take warfarin. You will also be given a contact number for advice. 3

4 What factors can affect warfarin and the INR? Other medicines: Warfarin is affected by many other medicines. This includes prescription and non-prescription medicines, vitamins and herbal supplements. You need to talk to your doctor before you stop any medicines or take anything new. Diet: Some foods interact with warfarin and affect your treatment and dose. Maintain a regular balanced diet and you should contact your doctor if you cannot eat your usual diet. Alcohol: Small amounts (up to three units per day) of alcohol are acceptable. One unit is roughly equivalent to half a pint of beer or lager, a single measure (25ml) of a spirit such as vodka, or a small glass (125ml) of wine. Avoid heavy or binge drinking while on warfarin. Illness: Illness may change the effect of warfarin. Contact your doctor if you experience vomiting or diarrhoea, fever or infection, loss of appetite, jaundice or any other illness. How can I reduce my risk of bleeding when taking warfarin? Bleeding is the most common side effect of warfarin. Bleeding becomes more likely as the INR increases. Following the advice given in this leaflet should minimise your risk of bleeding. Aspirin and medications such as buprofen or diclofenac as a treatment for pains and fevers are best avoided while on warfarin as they increase the risk of bleeding. If used as directed, paracetamol and codeine are safe to use with warfarin. Tell your doctor, surgeon or dentist about warfarin before any procedures that could cause bleeding. 4

5 Can I play sports? You should try to lead as normal a life as possible but due to risk of bleeding: Contact your doctor before starting any activity that may cause injury. Sports such as football, rugby, cricket and hockey are best avoided if played competitively. Martial arts, boxing and kickboxing must be avoided. What to do if I am bleeding? Increased and easy superficial bruising after minor injury is usual in people taking warfarin. Contact your doctor if you have any signs of unusual bleeding that is heavier than usual or takes a long time (over 15 minutes) to stop. This includes nose bleeds, bleeding from your gums, bleeding from cuts and scrapes and heavier than usual menstrual periods. You should seek urgent medical help in the event of: severe bruising (not due to injury); red or dark urine; red or black bowel motions; coughing blood; dark or blood stained vomiting; severe headache or dizziness; pain or swelling. How is bleeding treated? Depending on the symptoms, your doctor will do one or more of the following: Order a blood test Reduce the dose of warfarin Stop your warfarin for a few days or longer Give an antidote to warfarin (vitamin K) orally or in the vein Admit you to hospital and give blood products to urgently reverse the warfarin effect (if bleeding severely) 5

6 When do I stop taking warfarin? Do not stop taking warfarin unless advised by your doctor. If you can t take your warfarin for any reason, such as illness, tell your doctor immediately. Blood clots may form if you stop warfarin before it is safe. Your doctor will tell you how long you need to take warfarin, and when you can stop at the start of your treatment. Make sure you know who is going to tell you when to stop and when to see them. This can be your specialist or GP. After stopping warfarin your blood will return to normal in a few days. What if I move or change my phone number? You should always tell the anticoagulation clinic if your contact details change as we may need to contact you by phone about your INR result. Large print and translations For this leaflet in large print, please ring or For help in interpreting this leaflet in other languages, please ring Your health records To enable us to improve the quality of the care that we provide, your health records are kept by the Trust and may be used for teaching, training, audit and research. Further information on how the Trust uses your information can be found on our website at Reference: BH/PIN/46 Publication date: All our patient information leaflets are reviewed every three years. 6

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