What are anticoagulants ?
An anticoagulant medicine prevents harmful blood clots from forming in your blood vessels. It makes your blood take longer to clot. Warfarin is the most commonly used oral anticoagulant in India.
How do I take my anticoagulant ?
• Warfarin is taken once a day, at about the same time, preferably on an empty stomach. Take warfarin at 6 pm everyday.
• If you miss one dose of warfarin, or take a different dose to that recommended, please write it in the 'important information' section of your anticoagulant records sheet and go back to your normal dose the next day.
• Repeat prescriptions for warfarin may be obtained from your local doctor.
• Ensure that you have all three strengths of warfarin tablets (1mg, 3mg and 5mg)
Do I need monitoring while taking anticoagulants ?
Yes, you need to have a blood test called an INR. INR stands for International Normalised Ratio. This is a standard test that measures how long your blood takes to clot. (Normal blood has an INR of approximately 1). The warfarin dose that you need to take will depend on your INR test result. If your result is out of the range appropriate to your condition, the warfarin dose will be increased or decreased accordingly. The warfarin dose required to achieve the target INR set varies for each individual.
Monitoring of Anticoagulation
• Your yellow Anticoagulation Record sheet is divided into two sections: the top section is your records, and the bottom section is the request form for your next INR blood test.
• It is important that the yellow anticoagulation book always accompanies your blood sample for INR testing.
• Your INR test result, dose recommendation and date by which you should have the next INR test will be printed onto the top section of your anticoagulation record sheet. If necessary we will phone you. Please make sure your phone number is in the yellow book.
• Please arrange for your blood tests Monday to Saturday only.
• Initially you will have a weekly INR test; however when your INR is within your intended range you will have longer intervals between INR testing.
Are there any side effects ?
The most serious side effect of warfarin is bleeding
• Nosebleeds, Bloodshot eye(s)
• Blood in vomit, Blood in sputum
• Passing blood in your urine or stool, Severe or spontaneous bruising.
If you cut yourself, apply firm pressure to the site for at least five minutes using a clean, dry dressing. Seek medical advice immediately if you suffer a major injury or are unable to stop the bleeding.
What can affect the control of my anticoagulation ?
1. Other medicines
• Almost any drug can interact with warfarin.
• When buying over the counter drugs ( i.e directly from chemist), including alternative remedies (like homeopathy or ayurvedic medicines), tell the doctor or the chemist that you are taking warfarin.
• If you start any new medication while you are taking warfarin we recommend you have a blood test five to seven days after starting the new medication. In this way we can ensure that your INR remains within the desired range.
• If you have a course of antibiotics you should have an INR test within three days of starting them.
• You should not take aspirin unless it has specifically been prescribed by your doctor.
• It is also advisable to avoid non - steroidal anti-inflammatory drugs like diclofenac or ibuprofen (eg. Combiflam, voveran)
• Paracetamol and codeine based painkillers are acceptable
• It is important to eat a well balanced diet, keep to a regular diet.
• Be aware that any major changes in your diet may affect how your body takes up warfarin.
• Avoid green leafy vegetables (palak, methi etc), chick peas (Chole), egg yolks etc
• It is dangerous to 'binge' drink( excessive, sudden intake) while taking warfarin.
Who must I tell that I take anticoagulant therapy ?
• Tell any doctor prescribing your medicine that you currently take warfarin.
• Tell your dentist.
• Please carry with you the alert cards or your anticoagulant record sheet, which indicate that you are taking warfarin.
Advice for women
• Our service recommends that women do not conceive while taking warfarin. If you think you may be pregnant contact your Gynaecologist immediately for advice.
• You may breast feed while taking warfarin.
• You may experience heavier periods while you are taking warfarin
Our aim is to anticoagulate you safely and effectively!