1. Warfarin (Coumadin® / Jantoven®)
Presented by
Anticoagulation Team (ACT)

2. OBJECTIVES To provide house wide education to staff and patients
To promote consistency in teaching the patients
To reduce complications when patients receive warfarin (Coumadin/Jantoven)

3. What is warfarin (Coumadin® / Jantoven®)?
Warfarin is an anticoagulant
Anticoagulants help reduce the number of clots forming in blood.
Warfarin is referred to as a “blood thinner,” however; it does not affect the thickness of your blood.

4. What is the difference between warfarin and Coumadin®/ Jantoven®?
Coumadin®/Jantoven® are the brand names for warfarin
They are all the same drug and will work the same way
To avoid confusion, always get your warfarin refilled at the same pharmacy

5. Why do I need to take warfarin?
There are many reasons people need to
take warfarin. The most common reasons are:
Previous heart attacks
Atrial Fibrillation
Previous clots in your legs or lung
Heart valve replacement

6. How do I know it is working?
The effect of warfarin is shown in blood tests
The blood tests measure the INR (international normalized ratio), which tells how long it takes for your blood to clot
The INR goal is usually between 2-3 or
2.5 – 3.5, however, your healthcare provider will determine your exact goal

7. How often do I need to get bloodwork?
When you start warfarin your INR will be monitored at least once a week
The healthcare provider that manages your warfarin will determine when you need to come in for blood work
For your safety it is important not to miss these appointments

8. What affects my bloodwork (INR)?
Illness, diet, beverages, supplements, medications (prescription and over-the-counter), and certain disease states may affect your INR
Notify the healthcare provider managing your warfarin about any changes in your lifestyle, health, medications (including herbals and dietary supplements) at each visit. 

9. How do I take warfarin?
Take warfarin at the same time each day, preferably later in the evening
Take it exactly as prescribed
If you miss a dose, skip the missed dose. Do NOT double up!
Inform the healthcare provider managing your warfarin when a dose was missed as this may affect your blood levels

10. What are the risks of taking warfarin?
The most common side effect is bleeding. Examples may include:
Pink or brown colored urine
Red or tarry black stool
Heavier than usual menstrual flow
Excessive bruising or bruises that get larger
Cuts that won't stop bleeding after applying 20 minutes of continuous pressure 
Vomiting blood or something that looks like coffee grounds
Prolonged nasal bleeding

11. Should I only eat certain foods while I am on warfarin?
The main thing to remember is keep your diet consistent!!
Warfarin is balanced against the vitamin K in your diet (typically found in green, leafy vegetables).
Varying the amount of foods high in Vitamin K may cause fluctuations in your INR.
Keep your intake of alcoholic beverages consistent (ie: avoid binge drinking).

12. What are some foods high in Vit K? Moderate High High
Brussels sprouts 1/2
Raw spinach
Raw turnip greens
Raw Broccoli
Endive lettuce
Romaine lettuce
Above serving size is 1cup
Kale
Collards
Swiss chard
Parsley, raw
Mustard greens
Above serving size is ½ cup

13. How do I keep my intake of Vitamin K consistent?
Know the foods that are moderate or high in Vitamin K and be consistent with eating them
Report any significant changes in your diet or your weight to the healthcare provider managing your warfarin
Check with the healthcare provider managing your warfarin before taking any vitamins or herbal supplements

14. What drugs interact with warfarin?
Inform the healthcare provider managing your warfarin when starting or stopping any medications, vitamins, minerals, herbals, dietary supplements or dietary beverages
Avoid medications for headaches, pain relief, and fever as they can increase the risk of bleeding.
Some examples may include: ibuprofen, naproxen, aspirin
When pain/fever relief is needed, occasional use of Tylenol® (acetaminophen) is acceptable.

15. How do I identify that I am taking warfarin?
Always carry an Emergency Medical Identification Card with a list of current medications and their dosages
ID necklaces or bracelets that state you are taking warfarin are also available at local pharmacies
The ID will alert healthcare professionals in the event you are unconscious