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WARFARIN PATIENT EDUCATION AND ADVICE

What is Warfarin?

y  Anticoagulant helps prevent clots in the blood from forming

Uses

y  Prevention of DVT / PE, use in people with heart valves, AF or atrial flutter, stroke/TIA

How does it work?y  Vitamin K antagonist for blood factors made in the liver

How long does it take to work?

y  It starts working after 24hrs but does not get full effect until after 72-96hrs need to use heparin for the

first 4-5 days

y  A single dose works for 2-5 days however it is important to take the doses as prescribed to maintain the

correct level in the blood

What dose do I take?

y  5mg is usual starting dose (3mg if elderly or malnourished or liver failure or CCF ot high INR to begin with)

y  Most people start on 5mg once a day for the first 2 days and this dose is altered according to a blood test

called INR. This blood test basically measures how thick/thin your blood is. We want your INR to besomewhere between 2-3. (or 2.5-3.5 if valve)

y  Daily INR until 2x consecutive days within therapeutic range and then every 48hrs, adjusting the dose to

maintain within therapeutic range...

y  If the INR is too low = thick blood

y  If the INR is too high = thin blood

y  You will not know that the INR is too high or too low and therefore you need to have INR blood tests very

regularly at the beginning to make sure it stays within the normal range

Blood tests and monitoring

y  Daily every 2nd

day every few days weekly eventually every month

What about drug interactions?y  There are many drug interactions macrolides, steroids, antibiotics, amiodarone there are many!!

y  Always let your pharmacist know when getting OTC meds

y  Always tell doctors you are on it  some people like to have a medical alert bracelet for this purpose 

y  Never take alternative medicines unless you are sure they will not interact  St Johns Wort commonly

reduces the effect of warfarin greatly, Ginkgo increases

Missing a dose

y  Take as soon as you remember if on the day you were meant to take it notify your dr

y  If you have missed a dose and forget to take on the day dont take extra on the next day just take the usual 

dose

Medications you should AVOID;y  NSAIDs and aspirin

y  Vitamin K, C, E and other high potency vitamins multivitamins are OK if low potency

y  Certain laxatives ask pharmacist

y  Antacids just before taking warfarin  Mylanta etc

Foods and Warfarin

y  Cruciferous veges

y  etOH

y  Liver

Dont make drastic changes to your diet everything in moderation

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When to see a doctor straight away

y  Bleeding from the gums or bruising excessively

y  A cut that does not stop bleeding within 10mins

y  Bruises that appear suddenly and for no reason

y  Coughing up or vomiting blood / black stuff 

y  Bowel motions that are red or look like tar

y  If you have a bad fall, injure yourself in sports or hit your head even if you seem OK