Coumadin

What is an anticoagulant?

   An anticoagulant is used to prevent blood clots from forming in your body.  These clots may cause serious medical problems.  For example, if a clot moves to your brain, a stroke can occur. 

Why am I taking an anticoagulant?

   Anticoagulants are prescribed for various medical conditions such as heart arrhythmias like Atrial Fibrillation, heart valve replacements, and other medical conditions.  If you are not sure why your doctor has prescribed Coumadin, ask your physician.  It is important to know why you are taking this medication.

When do I take my anticoagulant?

   Take your Coumadin the same time each day.  It should be taken between 5-7pm.

How do I take my anticoagulant?

   It is important that you know the milligram dosage prescribed.  Coumadin tablets come in strengths ranging from 1mg to 10 mg.  It is your responsibility to know the color of your tablet, the dosage of your tablet, and how to figure the correct dosage. 

   Generally when Coumadin is prescribed, the doctor will instruct you to start on a particular dose.  You take that same dose each evening until advised to have your blood test drawn.  Your dose in milligrams may alternate from day to day.  You will want to keep a detailed record on a calendar so you know what dose to take each day. 

What do I do if I miss a dose?

   If you forget a dose, DO NOT take an extra dose of Coumadin next time.  Just take your next recommended dose as scheduled.  If you miss two doses, call your doctor’s office.

When do I have my blood work done?

   Anticoagulation therapy requires regular checks on your blood levels.  The test that is used to determine the thickness of your blood is called an INR (International Normalized Ratio).  This test is necessary to determine your dose of Coumadin.  When you are started on Coumadin, the doctor will give you a “Standing Order” lab slip that you need to present to your local laboratory to have the appropriate blood test when instructed.  “Standing Order” lab slip means that the lab slip is good for 1 year from that date at that particular laboratory.  The laboratory will keep the orders on file so when you need to check your Coumadin, use the same laboratory each and every time.  If you need to use another laboratory, contact your doctors’ office to advise a new lab slip needs to be sent to a different laboratory.  Keep your appointments for your blood test INR.  You should never go more than 4 weeks between blood tests. 

**Have your blood work done in the morning on the day you are due.**

How long will I be taking an anticoagulant?

   Some patients will only take an anticoagulant for a few weeks, where others will need to take an anticoagulant indefinitely.  Discuss with your doctor the length of therapy recommended for your specific situation.

Can I take a generic form?

   There are several generic forms on the market.  Unfortunately, generic forms of anticoagulants are not as efficient in regulating your blood levels as brand name form is.  Generics tend to cause more fluctuations in your blood levels which result in more frequent blood tests.  The brand form, Coumadin, is the only form we recommend. 

What does “therapeutic range” mean?

   Therapeutic range simply means the thickness of your blood levels.  Without any anticoagulants, a normal blood level is anywhere between 0.9 - 1.0.  The lower the blood level the “thicker” your blood is in relation to how fast your blood is clotting.  The higher the blood level the “thinner” your blood is in relation to how fast your blood is clotting. 

   Individuals who are taking anticoagulants for valve replacements are recommended to have an INR level from 2.5 - 3.5. 

   Individuals who are taking anticoagulants for heart arrhythmias or other medical conditions are recommended to have an INR level from 2.0 - 3.0.

   Your doctor may recommend different ranges on an individual basis.

Should I be concerned about interactions with this medication?

   Yes!  Your diet, health, and other drugs can also affect the way anticoagulants work in your body.  For this reason, follow these guidelines:

  1. Eat your usual amount of green leafy vegetables (spinach, broccoli, etc).These foods are high in Vitamin K, which the body uses to form blood clots. However, too much Vitamin K can interfere with the anticoagulant.

  2. For Coumadin to work as it should, keep the total amount you eat of these foods the same each day.Other examples of foods high in Vitamin K include: Asparagus, Avocado, Broccoli, Brussels Sprouts, Cabbage, Cauliflower, Coleslaw, Collard Greens, Endive,

    Garbanzo beans, Kale, Lentils, Lettuce, Liver, Mustard Greens, Sauerkraut, Soybeans, Spinach, Swiss Chard, Turnip Greens, Canola Oil, Soybean Oil, Mayonnaise, and Green Tea.

  3. If you drink alcohol, limit the amount you drink to one drink a day.Alcohol acts as a blood thinner.Excessive alcohol consumption can affect blood clotting and can cause internal bleeding.

  4. Aspirin should be used carefully with anticoagulants.Take only the prescribed amount of aspirin daily-No more and no less.Do not use aspirin as a pain reliever.Use drugs without aspirin such as Tylenol.Excessive use of pain medication can promote raw irritated stomach tissue that may bleed or ooze while on anticoagulants.

  5. Check with your doctor or pharmacist before taking over-the-counter drugs to be sure that they do not contain aspirin or other substances that might interfere with anticoagulants.

  6. Do not take any supplements that contain Vitamin K.If you take multivitamins or other supplements, check with your doctor or pharmacist to ensure they are safe.

  7. Many prescription drugs can interfere with anticoagulants.Take other prescription medicine only as prescribed by your doctor.Always remind your doctors that you are on anticoagulants whenever new medications are prescribed.

Are there any precautions with anticoagulants?

   Yes!  While you are taking anticoagulant medication, your blood will clot more slowly if you are injured.  Therefore, you should take precautions against even minor cuts and bruises.  In addition, you must be alert for signs that you may be bleeding internally.

        The following safety measures will help prevent problems:

Are there any precautions with anticoagulants?


   Yes!  While you are taking anticoagulant medication, your blood will clot more slowly if you are injured.  Therefore, you should take precautions against even minor cuts and bruises.  In addition, you must be alert for signs that you may be bleeding internally.

The following safety measures will help prevent problems:

  1. Use a toothbrush with soft bristles.

  2. Avoid putting toothpicks or other sharp objects in your mouth.

  3. Protect your feet from injury.Don’t walk barefoot and don’t trim your corns or calluses yourself.See a podiatrist if necessary.

  4. Inform all doctors (Dentists, Gynecologists, and Surgeons) that you are taking anticoagulants before receiving any treatment.

  5. Avoid rough sports.

  6. Avoid using cutting tools or other sharp objects that could result in injury.

  7. Protect yourself from falling.Use a non-skid mat in your bathtub or shower.Remove hazardous throw rugs.Wear low-heeled shoes with non-skid soles.

  8. If you cut yourself, keep pressure on the injury for 10 minutes.If the bleeding does not stop, call your doctor immediately.

  9. Report any large unexplained bruising.

  10. Check your urine and stools daily.Report any pink or red urine and any bloody or black tarry stools.

  11. Call promptly if any of the following occur:excessive nosebleeds, excessive headaches, bleeding gums, purplish or reddish spots on your skin, unusual vaginal bleeding or excessive menstrual flow, bleeding hemorrhoids, any serious fall or blow to the head, diarrhea, vomiting, or any fever that lasts longer than 24 hours.

  12. Carry either an identification card or a Medic-Alert bracelet at all times.It should include the name of the anticoagulant you’re taking and your doctors’ name and phone number.

  13. For Women:Coumadin is a drug that crosses the placenta and can cause serious birth defects.  Therefore, you should take precautions to avoid pregnancy while on this drug.  If you suspect that you are pregnant or plan to become pregnant, notify your doctor immediately

        NextGen Patient Education Material