Post-Op Protocols

About Coumadin

What You Should Know About Coumadin
Coumadin or Warfarin acts as an anticoagulant. It decreases the blood’s ability to clot and helps to prevent a harmful clot or thrombus from forming in your blood vessels.

Taking Your Medicine:
1. Take your Coumadin exactly as prescribed.
2. This medicine should be taken at the same time each day.
3. Be aware when the dose of the drug is changed.
4. Do not change the dosage on your own or stop taking the medicine unless told to do so by your physician or anticoagulation care provider.
5. If you miss a dose within a few hours, take it as soon as possible then go back to your schedule. If you do not remember until the next day, do not take the missed dose and do not double the next dose.

Taking Other Medicines:
Many medicines can increase or decrease the activity of Coumadin. To prevent bleeding and to keep your blood think enough to prevent clots, follow these precautions:
1. Do not take any medicines, even medicine you can buy without a prescription, without first talking to your physician or anticoagulation care provider.
2. Do not take aspirin except on your physician’s instructions. Always check to see if a product contains aspirin. Your pharmacist can suggest a non-aspirin medicine that you can use for mild pain.
3. Let your anticoagulation care provider know when you start taking any new medicine or when you stop taking a medicine.

Lifestyle:
1. Diet: Some foods can alter your response to Coumadin. It is very important to stay on the same type of diet you were on when the anticoagulant was first prescribed. Avoid major changes in your eating habits. Avoid any major changes in eating foods that contain a large amount of vitamin K, such as leafy green vegetables. Call your physician or your anticoagulation care provider if you are unable to eat for several days or if you have continuing diarrhea or fever.
2. Alcohol: Drinking too much alcohol can also change the way Coumadin affects your body. Your alcohol intake should be moderate (not more than 1-2 drinks per day), and you should avoid binge drinking. Keep your physician and pharmacist informed if there is any change in your alcohol intake.
3. Physical Activity: You are encouraged to exercise and engage in physical activities; however, since you can bleed and bruise more easily, avoid contact sports or other activities where there is a high chance of injury.

Laboratory Tests:
In order to be effective, your dose of Coumadin must be adjusted to keep your blood clotting within an acceptable range: delayed somewhat but not excessively so. If this balance is maintained, the drug will do the job it is designed to do with minimum risk of side effects or excess bleeding.

Some patients will continue to take Coumadin after they leave the hospital. A blood test, called a prothrombin time or INR, will be needed periodically to determine how fast your blood is clotting. Knowing your INR lets us know when and how to adjust your dose. Also, regular testing can help to prevent complications such as bleeding or clotting. It is very important that you have these tests done when you are scheduled to assist your care provider in monitoring your therapy. You should keep a personal record of your INR and Coumadin doses.

Signs of Unusual Bleeding:
While taking Coumadin, it is not unusual to note that you may bruise easily and that a cut takes a little longer to stop bleeding. If any of the following occur, however, notify your physician or primary care provider right away, or come in and see a physician.
1. Unexplained nosebleeds, prolonged nosebleeds, or excessive bleeding from the gums.
2. Excessive bleeding from cuts (more than 5-10 minutes.)
3. Black, tarry colored stools or bright red blood in your bowel movement.
4. Dark brown urine, cloudy urine, or red blood in your urine.
5. Unexplained bruising, excessive bruising, or purplish areas on the skin.
6. Unusually heavy or unexpected menstrual bleeding.
7. Vomiting blood or material that looks like coffee grounds.
8. Unusual headaches or dizziness.

Other Information:
1. Inform your physician if you are pregnant or nursing.
2. Before having dental work or any surgery, inform your physician, dentist or pharmacist that you are taking Coumadin. Prior to the dental work or surgery, contact your physician for instructions regarding your therapy.
3. Use a soft toothbrush.
4. Use an electric razor when shaving to prevent nicks.
5. Due to the increased bleeding tendency, you should carry a card in your wallet or purse stating that you are taking Coumadin. The card should give this hospital as a reference in case you are seriously injured in an accident. You are also encouraged to wear a Medic Alert bracelet or necklace with this information. If you have any questions, speak with your pharmacist or physician.

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