Coumadin is a drug containing Warfarin sodium that prevents the formation of harmful clots in the veins and the growth of the clot, if any. There are two forms in pharmacies, 5mg and 10mg tablets.
In Which Situations Is It Used? In cases where the risk of clot formation is increased (heart valve diseases, mechanical prosthetic heart valve, various rhythm disorders, pre- and post-surgical periods); It is used to prevent or treat clot formation in the heart cavities, leg (deep vein thrombosis) or lung veins (pulmonary embolism).
How to use? It is appropriate to take Coumadin at the same time every day (preferably in the evening), on an empty stomach or on a full stomach, with some water without chewing.
How Is The Dose Adjusted? Coumadin prolongs the Prothrombin Time Test (PT), one of the indicators of coagulation system function. Since PT test results may vary depending on various factors, the dose of the drug is adjusted according to the INR (International Normalized Ratio) value for standardization. In healthy people, this ratio is around 1. However, before starting the drug, normal INR values are determined. It usually starts with a dose of 5mg (1 tablet per day). Depending on the situation, heparin can be used initially until the desired INR value is reached. Regular PT/INR check is done. If the desired INR level is reached, heparin is discontinued and only coumadin is continued, then it is measured twice a week and followed until it stabilizes. Afterwards, once a month INR measurement may be sufficient. The dose is adjusted to try to keep the INR value between 2-3 or 2.5-3.5 according to the indication of use by making regular INR monitoring.
What Should You Pay Attention To? Patients using Coumadin should be careful in terms of bleeding. Because it can cause serious and fatal bleeding. The likelihood of bleeding is higher at the start of treatment and at a higher dose (high INR values). Regular INR monitoring should be performed in all treated patients. More frequent INR monitoring, careful dose adjustment according to the desired INR value and, if possible, shorter-term treatment are beneficial in those with a high risk of bleeding.
In Which Situations Does the Risk Increase? If the INR value is above 5, contact your doctor immediately after stopping Coumadin; If you have an INR value above 10 or any unusual bleeding (prolonged nosebleeds lasting more than 10 minutes, blood with vomiting, blood in saliva, blood in urine or stools, black stools, severe or spontaneous bleeding from the gums, unusual headaches) , abnormal increase in menstrual bleeding, development of bruises in any part of the body without bumps), it is appropriate to stop Coumadin immediately and apply to the nearest health institution.
What Does Coumadin Interact With? Various drugs, vitamins, herbal supplements, over-the-counter drugs may interact with Coumadin and affect the drug dose or increase side effects. Therefore, patients using Coumadin should tell their doctor about all the drugs, vitamins, herbal supplements and over-the-counter drugs they are using and should not start any medication without consulting the doctor. , must not change or terminate.
Drugs effective against pain, fever and inflammation (drugs containing aspirin, ibuprofen, ketoprofen, naproxen called non-steroidal anti-inflammatory drugs); drugs that lower blood sugar (chlorpropamide, tolbutamide); drugs that prevent epileptic seizures (anticonvulsant) (eg phenytoin, phenobarbital); Glucosamine and various antibiotics used in cartilage and joint disorders increase the INR value and the risk of bleeding when used together with coumadin.
Herbs such as red pepper, chamomile, angelica, tansy, garlic, flaxseed, ginger, green tea, horse chestnut, monoecious, poplar bud, turmeric, lion’s tail, herbal medicines such as Ginkgobiloba, ginseng and alcohol increase the effect of Coumadin. they can cause bleeding.
On the other hand, since Coumadin shows its effect by suppressing the effect of vitamin K on clotting, taking foods containing excessive amounts of vitamin K also reduces the effect of Coumadin. Therefore, it would be beneficial to reduce the daily amount of foods containing high doses of vitamin K.
If we classify foods according to their vitamin K content: Foods containing high doses of vitamin K: Cabbage, spinach, chard, parsley, purslane, curly lettuce, chickpea, liver, green tea, broccoli, brussels sprouts, turnip, fish oil. Foods with moderate doses of vitamin K: asparagus, cauliflower, cheese, peas, coffee, avocado. Foods with low doses of vitamin K: Red meat, chicken, eggs, milk, bread, butter, carrots, celery, corn, green beans, onions, rice, tomatoes, potatoes, peppers, peanuts, pumpkin, apples, oranges, strawberries.
Some drugs (vitamin C (high dose), vitamin K, anti-thyroid drugs), herbal-based supportive treatments (Coenzyme Q-10 and St. John’s Wort) reduces the effect of coumadin.
Again, since the bacteria in yogurt is effective by increasing the production of vitamin K from the intestine, eating plenty of yogurt also reduces the effect of Coumadin.
If any dietary application is required, the dietitian should be informed that Coumadin is used. Since foods change the effect of Coumadin, the INR test should be repeated when there are significant changes in the diet for more than 7 days.
Use in Pregnancy: Coumadin may affect the development of the baby in the first trimester of pregnancy in proportion to the dose used. Women who plan to become pregnant and use these drugs should share and discuss their wishes with their doctor before pregnancy. Women who think they may have become pregnant while using Coumadin should have a pregnancy test done as soon as possible and should contact their doctor immediately if the result is positive. There is no known contraindication to breastfeeding while using Coumadin.
What Sports Can Be Done? While it is inconvenient to do activities with a risk of bleeding and sports such as boxing and karate while using Coumadin, there is no harm in doing activities that do not have a risk of bleeding.
How Should Dental Care Be? While using Coumadin, the teeth should be brushed gently with a soft brush, as hard blows can easily cause gingival bleeding, and be gentle when flossing. If spontaneous gingival bleeding occurs, this may be a sign that the Coumadin dose is too high. Before having dental treatment, the dentist should be told that Coumadin is used. If a tooth extraction or a procedure that may cause bleeding is to be performed while using Coumadin, the dose of the drug may need to be adjusted if necessary.
Which Pain Relief Can Be Used? If the use of pain medication is mandatory while using Coumadin, drugs containing paracetamol or codeine can be used within the knowledge of your doctor.
If Coumadin Is Taken More Than Necessary: In case of taking Coumadin in more doses than required, the doctor should be informed immediately and attention should be paid in terms of bleeding.
If Coumadin is Forgotten: If the time of a dose is missed (for example, if it is necessary to take it in the morning but is remembered in the afternoon), the daily dose should be taken as soon as it is remembered and then the normal use schedule should be returned. If a full day is forgotten, this should be noted and the drug should be used in its normal dose the next day; A double dose should never be taken to make up for missed doses.
As a result; Although many factors need to be considered while using Coumadin, the occurrence of undesirable situations can be kept to a minimum by informing the patient about this issue, regular INR monitoring, and active patient-doctor communication.