According to the American Heart Association, heart disease is the number one cause of death in the United States, and more than 75% of Americans over the age of twenty are afflicted with some type of heart disease.
Drugs for the treatment of heart disease are numerous, and one of the more common agents prescribed for certain heart conditions is warfarin.
Warfarin is a blood thinning agent, or anticoagulant. It prevents clots from forming in the blood and reduces the potential for clot-related conditions. Warfarin is generally considered a "high alert" medication, meaning it should be used carefully and closely monitored. Although it is well researched and widely used, warfarin may cause problems if not taken correctly. Warfarin patients should follow certain guidelines to protect against these complications.
Regular Lab Tests
Warfarin patients should remain under the care of a physician, and submit to periodic laboratory testing. These tests tell your doctor how well warfarin is working, and may lead your physician to adjust your dose up or down.
Dosing Regimen
It is best to take warfarin at or around the same time daily, to maintain consistent drug levels within the body. If you miss a dose, take it as soon as you remember, but do not take two doses at once, as this can cause unwanted increases in warfarin levels.
Dietary Concerns
Warfarin works by inhibiting vitamin K, a natural component of the blood clotting process. While taking warfarin, it is best to limit intake of vitamin K. This does not mean you must avoid it altogether, but you should be judicious and consistent with the amounts of vitamin K you consume.
Vitamin K is found in many foods, most commonly leafy greens and some oils. A list of vitamin K rich foods may be found here.
It is also best to limit or avoid the intake of alcoholic beverages while taking warfarin. Alcohol—depending upon the amount consumed— can cause unwanted fluctuations in warfarin levels.
Warfarin with Other Drugs
Warfarin is noted for having interactions with aspirin and other anti-inflammatories. Unless a physician instructs otherwise, it is best to avoid aspirin and related products while taking warfarin. Warfarin also interacts with numerous other drugs, and an extensive list can be found here.
Before adding any drug to your regimen, prescribers should be made aware of your warfarin use. Double-check with your doctor or pharmacist before taking any over-the-counter medications while on warfarin. It is also a good idea to get your prescriptions filled at one pharmacy, making it easier to screen for interactions.
Signs and Symptoms of Too Much Warfarin
Because warfarin acts to thin the blood, most of the signs of warfarin toxicity relate to bleeding or evidence of bleeding. Any one of these symptoms can indicate high warfarin levels and should be brought to the attention of a physician:
- Excessive bruising, numerous broken blood vessels under the skin, bruising that occurs with a slight touch
- Excessive bleeding from a cut, nosebleed, or other injury that won't seem to stop or excessive bleeding while brushing the teeth
- Evidence of possible internal bleeding: "coffee ground" vomiting, blood in stool, blood in urine
Other Reasons to Seek Medical Attention
If you suffer a head injury, especially if consciousness is lost, seek medical attention to make certain there is no bleeding present in the brain. Swelling or pain in the legs, especially after prolonged periods of inactivity may indicate the formation of a blood clot, and signify decreased warfarin levels. Shortness of breath, painful breathing, or chest pain could indicate a clot within the lungs or coronary arteries.
Other Advisements
Physical activity is fine during warfarin therapy, but patients may wish to limit recreation that increases the likelihood of injury.
Make certain that caregivers and all health care providers (including dentists) are aware of your warfarin use. Medical alert bracelets and wallet cards are available for warfarin patients as well.
Each dose of warfarin is available in a different colored tablet. Patients should familiarize themselves with the dose and color of their tablet(s). Being able to visually identify your medication allows you to verify the accuracy of your refill.
Warfarin was approved for medical use in humans in the early 1950s. Decades of research have helped health-care practitioners learn how to effectively and safely use warfarin. Although still considered a "high alert" medication, patients who adhere to therapy guidelines and remain under the care of a physician typically do well and experience few causes for concern.
The information presented here is not intended to substitute for the care of a physician. The author assumes no responsibility for events resulting from the use or misuse of this information.
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