Central Missouri Cardiology


Coumadin/ Warfarin General Instructions

Warfarin is the generic name for Coumadin which is the brand or trade name drug. Warfarin (also known as Coumadin) belongs to a class of medications called anticoagulants. These drugs (anticoagulants) help prevent dangerous blood clots from forming in your blood. Your physician has prescribed this drug because you have a medical condition which puts you at risk for the formation of these dangerous blood clots; or you already have blood clots present.
You are taking Warfarin/Coumadin because you are at risk for forming blood clots which can lead to stroke or death if left untreated.
Warfarin/Coumadin is a medication that you therefore need to carefully, and sometimes frequently, monitor with a laboratory test called a protime or INR. The INR test stands for International Normalized Ratio which is the preferred test used by our office. The INR is a measure of how much Warfarin/Coumadin is in your system by calculating how fast your blood clots. When you are given instructions you will be instructed on your INR level for regulation of your Warfarin/Coumadin dose according to a goal or target INR level. The target level is determined by your physician according to your medical condition.
A high INR level means your blood is not clotting very fast and you are more likely to bleed.   (The higher the number the thinner your blood is.)
A low INR level means your blood is clotting very fast and you are more likely to form clots. (The lower the number the thicker your blood is.)
The most important item to remember when taking your Warfarin/Coumadin is to be consistent. Try to take your medication at the same time every day, preferably in the evening; but pick a time when you will remember it. If you miss a dose of Warfarin/Coumadin take the missed dose as soon as possible on the same day. Warfarin/Coumadin can be taken with or without food. 
If you miss a dose of your medication and do not remember to take it that day; DO NOT double dose the next day. Please write down the day you missed and/or inform us when you are here for your next INR.
Overall consistency in your diet, medications and use of alcoholic beverages can enhance the stability in which Warfarin/Coumadin is absorbed. The absorption of Warfarin/Coumadin can be affected by changes in your eating habits, exercise or sleep patterns, your overall health, and medications (both over-the-counter and prescription medications). Maintaining regular daily habits including a consistent diet and exercise routines should make it less likely we will need to adjust your dosing as frequently. However, because your Warfarin/Coumadin level can be affected by so many outside factors the most important precaution is to check your INR regularly.
Illness, diet, exercise and other medications can affect your INR level.
Check your INR regularly to avoid complications with your Warfarin/Coumadin.
Be consistent in your diet, exercise routines, and alcohol consumption.
Remember to tell us if you consume alcohol if it is not part of your daily routine.
Your diet is a major factor that can affect the stability of your Warfarin/Coumadin level. Vitamin K is found in many foods and is an important factor for blood to clot. This is especially important in patients taking Warfarin/Coumadin because high amounts of Vitamin K rich foods can work against the Drug. The highest amount of Vitamin K is found in green and leafy vegetables like lettuce, spinach and broccoli, however some things like salad dressings have high amounts also. The most important thing to remember is to eat what you normally eat, but be consistent with your Vitamin K foods.
Keep your diet the same. If you normally eat a salad for lunch, then keep eating that salad for lunch!
Do not attempt to adjust your Warfarin/Coumadin level with your diet. Example: If you feel you are thin you increase your greens without an INR level.
Another important factor in maintaining a stable Warfarin/Coumadin level is to notify us if your medications change. Many medications, including prednisone and most antibiotics can cause an elevation in the level of Warfarin/Coumadin absorbed and it will be important to check an INR if these medications are started. Herbal and over-the-counter medications including nutritional supplements can also affect your blood levels adversely.
Most prescription medications will be safe to take with Coumadin especially if they will be taken daily.
Do not start any supplements, herbals or over-the-counter medications without checking with your doctor or the Coumadin clinic first.
Remember to have your INR checked after starting a medication to avoid possible complications with your level.
Complications with Warfarin/Coumadin can occur despite diligence with the therapy.   If you have any abnormal symptoms which you feel may be caused by your Drug; please call and report to the nurses. Complications with Coumadin can be minor bleeding you may notice from time to time, or a major bleeding complication you should report right away or go to the emergency room.   Minor bleeding can be helped with a soft toothbrush to protect your gums and an electric razor to prevent cuts while shaving. Avoiding sports or activities that may result in a serious fall or injury will prevent major bleeding complications.
Alert your dentist and other healthcare providers you are taking Warfarin/Coumadin.
Report any major bleeding episodes to our office or the emergency department immediately.
Report any serious accidents or injuries, especially those which involve a serious fall or hit to the head.
Major bleeding symptoms can include the following:
            Red, dark or coffee colored urine.
            Bowel movements that are red or look like tar. 
            Excessive bleeding from the gums or nose.
            A cut or wound which will not stop bleeding after pressure held for ten minutes.
            Any blood or coffee colored substance when you cough or vomit.
            Excessive menstrual bleeding.
            Unusual bruises or bruises that won't heal.
 Remember Warfarin/ Coumadin can be a very safe and effective drug when properly taken and monitored.   Try to be as consistent as possible in all your daily activities. Do not hesitate to call or ask us if you have any questions or concerns about your dosage and use of your Warfarin/ Coumadin. Remember the right dose of Coumadin is highly individualized and needs to determined and adjusted by your physician.
Foods High in Vitamin K Content:                                  
Artichokes, Celery, Carrots and Cauliflower                     
            Beans, raw pod and snap                     
            Apple peel, green                                 
            Blackberries, raw                                 
            Blueberries, frozen and raw                           
            Broccoli, boiled, frozen and raw                        
            Cabbage, boiled and raw
            Brussel sprouts
            Carrot juice, canned
            Chips, olestra and Cheetos
            Chives, raw
            Collard greens                         
            Canola Oil
            Cucumber skin
            Tuna fish in oil
            Pistachio and pine nuts
            Instant oatmeal
            Okra, boiled and frozen
            Parsley, al l forms
            Peas, all kinds
            Dill pickles
            Fresh Prunes
            Rhubarb, frozen
            Canned pumpkin
            French, Italian, and Ranch salad Dressing
            Canned Sauerkraut
            Soybeans and soybean Oil
            Spinach, all forms
            Green and Black tea leaves
            Watercress, raw
            Liver, All kinds