Losing The War With Warfarin?

Do you feel like you’re losing the war with warfarin?

You have your annual doctor’s visit, which includes a brief conversation about “anticoagulation” or “INR” and receive a prescription for warfarin, which requires blood tests every few weeks. The conversation goes on to detail dietary restrictions, including foods and over-the-counter medications you should not take while on this drug, along with a long list of side effects.  Walking out with a dazed look from information overload you ask yourself “What does this all mean?” Here’s the break down.

What is Warfarin?

Warfarin is a medication that thins the blood. You may have been given this medication because when your blood is too thick, this can cause the blood to stick together. When this happens, it forms a “clot,” which can travel to the heart or lungs and be dangerous. Sometimes this can cause a heart attack or stroke, which is why this medication might be needed.

Because of the way warfarin works, it takes several weeks to see the full effect. This is why your doctor will start you on a low dose and your doctor or pharmacist will monitor your blood every few weeks to make sure it is not too thin or not too thick for a healthy body. Blood thickness is measured using an “INR” test, which shows how long it takes for your blood to clot. If you are taking warfarin at the right dose for your body, your value should be between 2 and 3.

Greater than 3 means your blood is too thin and you could be at an increased risk for bleeding, while too low means your blood is too thick and can clot. It is VERY IMPORTANT for you to know when your next INR appointment is for blood work to stay healthy.

Dietary Restrictions

When it comes to diet and warfarin, consistency is key. If you keep your diet consistent when taking warfarin, a dose can be determined that goes along with your current diet. Some foods that are high in Vitamin K can decrease the effect of warfarin, making the blood more thick. These include:

·         Kale

·         Spinach

·         Brussels sprouts

·         Parsley

·         Collard greens

·         Mustard greens

·         Chard

·         Green tea

While the foods above decrease the effect of warfarin, grapefruit juice, cranberry juice, and alcohol can all increase the effect of warfarin. It is always a good idea to eliminate alcohol in the diet when using warfarin or limit use to one glass per day.

Medications such as aspirin or aspirin-like drugs and nonsteroidal anti-inflammatory drugs (NSAIDs such as ibuprofen, naproxen, celecoxib) may have effects similar to warfarin. It’s important to ask your doctor or pharmacist before using these over-the-counter products.  Acetaminophen (Tylenol) is usually a good alternative in these cases.

Warfarin and Herbs

Certain herbal medications also affect warfarin, so ask your doctor or pharmacist before beginning any of the following: bromelains, coenzyme Q10, danshen, dong quai, fenugreek, garlic, ginkgo biloba, ginseng, and St. John’s wort, among others. If you take a daily vitamin, it might have Vitamin E, which can also increase the effects of warfarin.

Side effects of warfarin almost always revolve around signs of bleeding. When on warfarin, bleeding will sometimes not stop or there may be bleeding you cannot see. If you have a cut, bleeding gums, or experience a fall, be sure to get help right away.

Your provider prescribed this medication because the benefits outweigh the risks. As always, never hesitate to contact your healthcare provider or pharmacist with questions.

References:

1. https://www.webmd.com/drugs/2/drug-3949/warfarin-oral/details

2. https://www.mayoclinic.org/diseases-conditions/thrombophlebitis/expert-answers/warfarin/faq-20058443

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