Coumadin _warfarin_ Anticoagulan

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					 Coumadin (warfarin)
Anticoagulant Therapy

               Presentation by
                James Rowley
Coumadin is the trade name for a common oral
  anticoagulant called warfarin

Anticoagulants such as warfarin are commonly
  referred to as “blood thinners”; however, they
  do not actually “thin” your blood, but increase
  clotting time to prevent blood clots from forming
  too quickly

Anticoagulant therapy is used to prevent formation
  of harmful blood clots that may lead to:
• Stroke
• Heart Attack
• Deep Vein Thrombosis
• Pulmonary Embolism
Risk Factors

Patients at risk include patients with:
• Atrial Fibrillation – a common heart dysrhythmia
• Deep Vein Thrombosis – blood clots that form
  in deep veins of the lower extremities
• Artificial Heart Valves
• Various Clotting Disorders
How does it work?

The formation of blood clots in the body is
  controlled by a series of “clotting factors”, one
  of which is dependent on Vitamin K

Warfarin interferes with the formation
 of Vitamin K dependent clotting
 factors, increasing the length of
 time and reducing the bodies
 ability to form blood clots
Monitoring PT/INR

The goal of anticoagulant therapy is to
decrease the clotting tendency of blood to
prevent harmful blood clots, not to prevent
blood from clotting completely!
Monitoring PT/INR

 The blood test used to monitor clotting times is
  the Prothrombin Time (PT), which has been
  standardized to be reported as an International
  Normalized Ratio (INR)
 Therapeutic range for most patients is and INR
  between 2.0 – 3.0
 If the INR is too low, harmful blood clots may not
  be prevented; but if the INR is too high there is
  an increased risk for bleeding
 Dosing will be closely regulated to achieve a
  stable therapeutic level
Since warfarin interferes with Vitamin K
dependent clotting factors, diet plays an
important roll in maintaining a stable,
therapeutic level
 Vitamin K is most commonly found in green
  leafy vegetables
 Increased Vitamin K intake will reduce the
  anticoagulant effect of warfarin and increase
  the risk of harmful blood clots
 Most importantly, keep the Vitamin K intake in
  your diet CONSISTENT so that dosing may be
  adjusted to maintain a stable INR within the
  therapeutic range
Vitamin K Rich Foods
• Broccoli          • Arugula
• Spinach           • Cucumbers
• Lettuce           • Green Peas
• Cabbage           • Green Tea
• Brussel Sprouts   • Collard Greens
• Avocado           • Watercress
• Pears             • Turnips
• Cauliflower       • Vegetable Oil
• Asparagus         • Liver
Side Effects

Complications associated with anticoagulant
therapy are related to either blood clotting due
to under-dosing or excessive bleeding
 When doses are too low or Vitamin K intake is
  increased the INR will fall below therapeutic
  range and formation of harmful blood clots may
 When doses exceed the necessary amount and
  INR is too high excessive bleeding may occur
Call 911 or contact your healthcare provider
immediately if you experience any of the
following adverse effects:
• Coughing/vomiting blood
• Bloody or dark stool
• Blood in urine
• Severe or unusual headache
• Confusion, weakness or numbness
• Bleeding that will not stop
*Report any falls, accidents or unusual
  bruising to your healthcare provider!
Crawford, M. (2009). Dietary manipulation to stabilize INR. Clinical
   Cardiology Alert, 28(11), 87-88.
Fiumara, K, & Goldhaber, S. (2009). A patient's guide to taking
   coumadin/warfarin. Circulation, Journal of The American Heart
   Association, 119, 220-222.
Kneeland, P, & Fang, M. (2010). Current issues in patient adherence and
   persistence: focus on anticoagulants for treatment and prevention of
   thromboembolism. Patient Preference and Adherence, 4, 51-60.
Jacobson, B, Schapkaitz, E, Haas, S, Dalby, T, & Mer, M. (2007).
   Maintenance of warfarin therapy at an anticoagulation clinic. SAMJ
   Forum, 97(12), 1259-1265.

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