Living with Anticoagulation

Living with anticoagulation is manageable, with the right support and resources. We are here to help, if you have any questions or concerns, please call the anticoagulation team.
 

Side Effects

The major complication associated with Coumadin® is bleeding due to excessive anticoagulation. Excessive bleeding or hemorrhage can occur from any area of the body. If you are on this medication you should report any falls or accidents, as well as signs and symptoms of any unusual bruising or bleeding. Signs of unusual bleeding include; bleeding from the gums that won’t stop, blood in urine, bloody or dark stool, a nosebleed that won’t stop, or vomiting blood.

Coumadin® can also cause skin necrosis and gangrene, which can cause dark red or black areas on the skin. This is a rare complication that may occur during the first several days of therapy. 

When to seek help
You should call your health care provider immediately if there are obvious or subtle signs of bleeding, including the following:

• Serious fall or blow to the head
• Persistent nausea or vomiting blood/material that looks like coffee grounds
• Headaches, dizziness, or weakness
• Nosebleeds or gum bleeds that do not resolve quickly 
• Dark red or brown urine
• Blood in the bowel movement or dark-colored stool
• Menstrual bleeding that is heavier than normal/bleeding in between periods
• Coughing up blood
• Severe head or stomachache
• Unusual/large bruising
• A cut that does not stop bleeding
• Pain, discomfort, or swelling — especially after an injury
• After a serious fall or head injury even if there are no other symptoms
• Swelling or pain at an injection site
• Inability to eat for more than 24 hours
• Fever greater than 100.4° F

It is important to remember that Coumadin® is taken to reduce the risk of a serious clotting condition, such as deep vein thrombosis or pulmonary embolism. If one or more of the above symptoms develops, you should seek immediate medical attention.  

 

Important Safety Information

Take Coumadin® on a schedule
Take Coumadin® exactly as directed. Do not increase, decrease, or change the dose unless told to do so by your health care provider. If a dose is missed or forgotten use the instructions below or call your prescribing provider for advice.

Coumadin® tablets come in different strengths; each usually a different color, with the number of milligrams clearly printed on the tablet. If the color or the dose of the tablet appears different from those taken previously, you should immediately notify your health care provider.

What do I do if I miss a dose?
It is important that you do not miss any doses of your Coumadin® therapy. Use your pill box to help prevent missing your medication. If you do miss a dose and remember within 12 hours of the originally scheduled time, you may still take your dose. If you are scheduled to take your next dose in less than 12 hours, DO NOT TAKE the dose you missed. Be sure to mark the missed dose on your calendar and remember to report it to the anticoagulation management nurse at your next appointment.

Reduce the risk of bleeding
There is a tendency to bleed more easily than usual while taking this medication. Some changes that are encouraged and recommended to decrease your risk include:

• Use a soft bristle toothbrush
• Floss with waxed floss rather than un-waxed
• Shave with an electric razor rather than a blade
• Be extremely careful when using sharp objects, such as knives and scissors
• Avoid activities that have a risk of falling or injury, such as contact sports

Prevent Falls
Falling may significantly increase the risk of bleeding. Take the following measures to prevent falls:

• Remove loose rugs and electrical cords, or any other loose items in your home that could lead to tripping, slipping, and falling
• Ensure that there is adequate lighting in all areas inside and around your home, including stairwells and entrance ways
• Avoid walking on ice, wet or polished floors, or other potentially slippery surfaces
• Avoid walking on unfamiliar areas outside

Over the Counter Medication Interactions

If you need a medication for mild pain relief, we recommend using acetaminophen (Tylenol®).
Other-the-counter medications that are safe include:

• Benadryl®
• Maalox®
• Mylanta®
• Tylenol®

Some decongestants may not be safe to take with Coumadin® (warfarin). They may interact with your other medications. Please contact your health care provider or anticoagulation management nurse with questions.

Always inform your anticoagulation nurse of all over-the-counter medications you are taking.
 

Dry Nose-Nosebleeds

If you have a nosebleed lasting longer than ten minutes without any decrease in blood flow, please seek medical attention immediately and let the health care provider know you are on an anticoagulant. Call the anticoagulation clinic office after you have returned home so we can schedule your next blood draw and adjust your medication as needed.

Tips to help prevent dry nose or nosebleeds:

• Keep your room or house  well-humidified
• Drink plenty of fluids (six to eight cups of water), unless you are on fluid restrictions for medical reasons
• Use a saline nasal spray six to ten times a day (two sprays in each nostril)
• Use nasal moisturizers 
• Short term (less than four to five days): place a small amount of Vaseline or A&D ointment just inside your nose
• Longer periods: place a small amount of over-the-counter water-based lotion (Eucerin, Neutrogena, or equivalent) just inside your nose, two times a day

Diet Guidelines and Restrictions

Some foods can affect the way Coumadin® works in your body. These include foods high in vitamin K, cranberries, alcohol, and some herbs. The amount of vitamin K in your diet can affect the amount (dose) of Coumadin® that you need to take. Your dose must be balanced with your diet to give the best drug effect.

When taking your Coumadin® remember:

• You do not have to follow a diet low in vitamin K – eat foods that have a consistent amount of vitamin K. The key is to keep consistency; eating more or less of these foods than you normally do may change the way your blood clots while on Coumadin®. 
• Ask your provider if you should take a daily multivitamin with vitamin K – this may help keep your vitamin K levels consistent.
• Call your anticoagulation management nurse if you have any other questions regarding your diet.

Foods very high in vitamin K include: 

• Kale
• Spinach
• Turnip greens
• Collard greens
• Beet greens
• Mustard greens

Foods high in vitamin K include: 

• Asparagus
• Broccoli
• Brussels sprouts
• Dandelion greens
• Endive
• Lettuce (iceberg, bibb, Boston, and green leaf)
• Parsley
• Sauerkraut
• Scallions

Olestra
Foods with olestra (Olean) often have fat-soluble vitamins added, including vitamin K. These foods should be considered a source of vitamin K if they are in your diet.

Cranberries
Be consistent in the number of cranberries, amount of cranberry juice or cranberry supplements that you consume while taking Coumadin® - it can change the way it works in your body. Make sure to discuss with your provider or anticoagulation management nurse how many cranberry products are in your diet.

Alcohol
Drinking alcohol is not recommended with this medicine. However, if you do drink alcohol, be consistent in the amount you consume and limit your intake to one or two drinks per day. More alcohol than this can change the way your body responds to Coumadin®. Excessive drinking may elevate your International Normalized Ratio (INR), put you at a risk of injury, as well as increase your risk of bleeding.

Herbs
Use of herbal supplements may interact with Coumadin®. Several popular herbs, such as ginseng, St. John’s wort, ginger, garlic, and ginkgo biloba have been reported to affect how your body uses Coumadin®. Tell your health care provider, pharmacist, or dietician if you are taking any herbal preparations or if you are using any herbal teas or other products. Using herbs, such as garlic and ginger, in cooking is safe while on Coumadin®. 

Remember to tell your doctor or anticoagulation management nurse about any changes in your consumption of:

• the type or amount of food;
• the frequency and number of alcoholic drinks;
• herbal supplements.

Remember that vitamin K is present in green leafy vegetables, such as broccoli, cabbage, lettuce, and spinach. Do not make large changes in the amounts of these foods you eat every day while you are taking Coumadin®. 
 

Traveling while taking Coumadin®

You can still enjoy extensive travel if you are taking Coumadin®; just remember that proper planning is important. Make preparations for medication storage, determine laboratory locations, and take into account your diet and lifestyle choices. It is critical to keep your provider’s telephone number and a list of your medications with you at all times.

Medication Preparation
Order enough medication for the entire time you will be travelling. If you will be away for an extended period of time you should identify nearby pharmacies and make phones calls to ensure that all potentially needed dosages of your medication are available.

Carry medications in their original prescription bottles. By doing this, you could avoid problems with airport security. You are also encouraged to wear medical identification jewelry, in the unlikely event of an accident or reaction. And remember to always keep your health care provider’s phone number in an easily accessible location.

Testing During Travel
Follow your regular INR testing schedule. Identify a convenient lab to have your blood drawn for INR testing during travel, especially international travel. To find a reliable lab, contact a physician at the travel destination. If you self-test, follow your normal testing routine and call in the test results according to your provider’s instructions. 

Diet and Lifestyle
Traveling can often change your diet and lifestyle and that may affect how your body processes Coumadin®. Your INR results may show a fluctuation within three to five days after your travel begins. Maintain your regular INR blood-testing schedule and keep in close communication with your health care provider if your INR test results are out of your recommended range. 

Safe, stress-free travel means planning ahead. Create a simple checklist for your trip. It can help reduce stress and allow you to enjoy your travels.