How can I reduce the risk of warfarin side effects?
· Some herbal supplements that can affect the way warfarin works are ginkgo biloba, garlic, fish oil, vitamin E, and tumeric. Talk to your healthcare provider before you start or stop any medicines. Eat the same amount of vitamin K daily to help keep your INR stable. Vitamin K is found in green leafy vegetables, broccoli, grapes, and other foods.
Can You overdose on warfarin?
Patients not on warfarin therapeutically can be given 10 mg of vitamin K1 and repeat INRs as an outpatient. Titrating intravenous vitamin K with doses of 0.5 to 2.0 mg when INR > 5 is appropriate to reduce INR without causing warfarin resistance. The high-risk group must be kept anticoagulated, and warfarin resistance avoided. Publication types
What is warfarin used to treat?
· Some simple changes to decrease the risk of bleeding while taking warfarin include the following: Use a soft-bristle toothbrush Floss with waxed floss rather than unwaxed floss Shave with an electric razor rather than a blade Take care when using sharp objects, such as knives and scissors Avoid ...
What should I do if I experience bleeding while taking warfarin?
· Abstract. Warfarin, a vitamin K antagonist, is widely used for the prophylaxis and treatment of thromboembolic disease. While guidelines exist for management of a supratherapeutic international normalized ratio following therapeutic warfarin use, these guidelines are not designed for management of the acute warfarin overdose.
What is the treatment of warfarin overdose?
Warfarin has to be stopped, and parenteral vitamin K and fresh frozen plasma have to be administered. The most rapid way of reversing the anticoagulant effect of warfarin is by transfusing fresh frozen plasma.
What is the antidote for a INR that is too high?
If your INR is between 4 and 10, you might take some vitamin K in addition to skipping your medication for a few days. If your INR is higher than 10, you'll probably take vitamin K. You'll also want to stop taking warfarin and get frequent INR checks to make sure it's improving.
What happens if your warfarin is too high?
A value higher than 3.5 increases the risk of bleeding problems. Many things can affect the way warfarin works. Some natural health products and other medicines can make warfarin work too well. That can raise the risk of bleeding.
How is anticoagulant overdose treated?
Specific treatmentIf the PT is elevated, give phytonadione (vitamin K1), 10–25 mg orally, and increase the dose as needed to restore the PT to normal.Do not treat prophylactically—wait for the evidence of anticoagulation (elevated PT)More items...
How do you adjust warfarin if INR is too high?
A nice "rule of thumb" for dose adjustments near the target range (generally works for INRs from the high 1s to low 4s): If you want to change the INR by 0.5-1 unit, increase or decrease the weekly dose by a daily dose. Example: Your patient has been taking warfarin 5mg daily for more than 2 weeks and INR is 1.8.
How long does it take for INR to decrease?
In 5 patients studied in detail, the INR decreased exponentially and had a half-life that ranged from 0.52 to 1.2 days; the onset of maximal decrease began 24 to 36 hours after discontinuation of warfarin therapy.
How do you stop internal bleeding on blood thinners?
To stop the bleeding:Put a clean towel, cloth, or bandage on the wound.Press on it firmly until the bleeding stops (don't press on something stuck in your skin)Keep it in place with medical tape or your hands.Raise the injury above your heart if you can.
Is vitamin K the antidote for warfarin?
IV vitamin K has also been shown to be a safe and effective method of warfarin reversal. A dose finding study recommended 1 mg IV vitamin K for patients with an INR > 10.
What is the antidote for heparin and warfarin?
Abstract. Individuals anticoagulated with warfarin or heparin are typically treated with specific antidotes such as vitamin K or protamine, respectively, if they bleed or require surgery.
What Is Warfarin Toxicity?
Warfarin toxicity happens when you have too much warfarin in your body. Certain changes to foods and medicines can also increase the effect of warf...
What Increases My Risk For Warfarin Toxicity?
1. You take higher doses of warfarin than is recommended by your healthcare provider. 2. Your risk of warfarin toxicity increases if you do not hav...
What Are The Signs and Symptoms of Warfarin Toxicity?
1. Red spots on your skin that look like a rash 2. Severe headache or dizziness 3. Heavy bleeding after an injury 4. Heavy bleeding during monthly...
How Do I Safely Take Warfarin?
1. Go to all your follow-up appointments. Your healthcare provider will need to monitor you closely while you are taking warfarin. He may need to a...
What Else Should I Do While I Am Taking Warfarin?
Wear medical alert jewelry or carry a card that says you take warfarin. Ask where to get these items.
When Should I Seek Immediate Care?
1. You have a severe headache or dizziness. 2. You have heavy bleeding that does not stop. 3. You have severe stomach pain or you vomit blood. 4. Y...
When Should I Contact My Healthcare Provider?
1. You have fever and chills. 2. Your gums bleed when you brush your teeth. 3. You have frequent nosebleeds. 4. You bruise easily. 5. You have red...
How does warfarin toxicity occur?
Warfarin toxicity is common and usually results from dose changes or drug interactions. There are few reported cases of intentional overdose. The management of warfarin overdose is usually complicated by the patient using warfarin therapeutically, often for a mechanical heart valve or pulmonary embolus prophylaxis. Untreated patients have a significant bleeding risk, but treatment carries a significant risk of complete reversal of anticoagulation and consequent risk of thrombosis. The objective of this study was to describe warfarin overdoses and complications of treatment and develop a safe approach to management. Three patients are described. Two patients received a single 10-mg dose of vitamin K. Both required anticoagulation, and in one, warfarin resistance persisted for 2 weeks. In a third patient serial INR, factor levels and warfarin concentrations were measured, and incremental doses of vitamin K (up to 7.5 mg) were given based on INR. This patient did not require anticoagulation, and regular warfarin therapy was recommenced after 4 days. Patients intentionally overdosing on warfarin can be classified into three groups based on preexisting indications for warfarin: nontherapeutic, moderate risk, and major risk for thromboembolic complications. All patients should have regular INR measurements (6-hourly) to catch rapid rises. Patients not on warfarin therapeutically can be given 10 mg of vitamin K1 and repeat INRs as an outpatient. Titrating intravenous vitamin K with doses of 0.5 to 2.0 mg when INR > 5 is appropriate to reduce INR without causing warfarin resistance. The high-risk group must be kept anticoagulated, and warfarin resistance avoided.
What are the three groups of patients who overdose on warfarin?
Patients intentionally overdosing on warfarin can be classified into three groups based on preexisting indications for warfarin: nontherapeutic, moderate risk, and major risk for thromboembolic complications. All patients should have regular INR measurements (6-hourly) to catch rapid rises.
Can you overdose on warfarin?
Intentional warfarin overdose. Warfarin toxicity is common and usually results from dose changes or drug interactions. There are few reported cases of intentional overdose. The management of warfarin overdose is usually complicated by the patient using warfarin therapeutically, often for a mechanical heart valve or pulmonary embo …. ...
How to reduce bleeding while taking warfarin?
Some simple changes to decrease the risk of bleeding while taking warfarin include the following: Use a soft-bristle toothbrush. Floss with waxed floss rather than unwaxed floss. Shave with an electric razor rather than a blade. Take care when using sharp objects, such as knives and scissors.
Why is warfarin called an anticoagulant?
Because warfarin interferes with the formation of blood clots, it is called an anticoagulant (PDF). Many people refer to anticoagulants as *blood thinners; however, warfarin does not thin the blood but instead causes the blood to take longer to form a clot.
How does warfarin affect blood clotting?
The goal of warfarin therapy is to decrease the clotting tendency of blood, not to prevent clotting completely. Therefore, the effect of warfarin must be monitored carefully with blood testing. On the basis of the results of the blood test, your daily dose of warfarin will be adjusted to keep your clotting time within a target range. The blood test used to measure the time it takes for blood to clot is referred to as a prothrombin time test, or protime (PT). The PT is reported as the International Normalized Ratio (INR).
What to wear for warfarin?
Wear Medical Identification. Those who require long-term warfarin should wear a medical alert bracelet, necklace, or similar alert tag at all times. If an accident occurs and the person is too ill to communicate, a medical alert tag will help responders provide appropriate care.
Does warfarin help with blood clots?
Warfarin decreases the body’s ability to form blood clots by blocking the formation of vitamin K–dependent clotting factors. Vitamin K is needed to make clotting factors and prevent bleeding. Therefore, by giving a medication that blocks the clotting factors, your body can stop harmful clots from forming and prevent clots from getting larger.
Why are generic drugs less expensive than brand names?
Generic drugs are often less expensive than their brand-name counterparts, because the generic manufacturers have not incurred the expenses of developing and marketing a new drug.
Is Warfarin a foreign drug?
Foreign drugs may use identical or potentially confusing brand names for products with active ingredients that differ from U.S. drugs. Warfarin has many foreign brand names (Table 1). Patients who do fill prescriptions abroad should ensure the accuracy and quality of the medication dispensed.
What is warfarin used for?
Warfarin is used to treat and prevent blood clots that might result in heart attack, stroke, or death. It’s also used for blood clots in atrial fibrillation, heart valve replacement, venous thrombosis, and pulmonary embolism.
How does warfarin work?
Warfarin works by stopping your body from forming blood clots. It does this by blocking the formation of blood clotting factors, which are needed to make clots.
What enzyme breaks down warfarin?
CYP450 enzyme helps your body to break down and process medications. Drugs that affect this enzyme may affect how your body handles warfarin.
Is warfarin a short term drug?
Warfarin may be a short-term or long-term drug treatment. How long you take this medication depends on your condition. It comes with risks if you don’t take it as prescribed.
Does warfarin increase bleeding?
Your risk of bleeding is increased when you take warfarin with selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs). Examples are:
Can you take Warfarin with other medications?
Warfarin oral tablet can interact with other medications , vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.
Is Warfarin a prescription drug?
Warfarin is a prescription drug. It comes only as a tablet you take by mouth.
What to do if you take more warfarin than prescribed?
If you take more warfarin than prescribed, contact your healthcare provider or a poison-control line right away.
What changes the amount of warfarin you need?
Many factors can change the amount of warfarin you might need. These include changes in other medications or changes in diet.
What is warfarin used for?
Warfarin is sometimes prescribed for a variety of medical conditions. Warfarin is commonly used to treat people with different kinds of blood clots, such as: Venous thrombosis (a blood clot in the veins of the leg) Pulmonary embolism (a blood clot that lodges in the lungs)
How to find the right dose of warfarin?
To help find the right dose, you will need to take blood tests that assess how easily your blood clots. The main tests used are an international normalized ratio test and a prothrombin time, also known, respectively, as an INR test and PT test. These are both blood tests that measure how easily and quickly your blood can clot. In a person not taking warfarin or another anti-coagulation medication, the result of a typical INR test is around 1.0. The goal for people taking warfarin is usually to get an INR between 2.0 and 3.0.
What to do if you are pregnant while taking warfarin?
They can advise you whether you should stop taking the medication . Don’t wait for your appointment to ask.
What foods can cause a bleed from warfarin?
Other foods can increase your chances of bleeding due to warfarin. These include alcohol, grapefruit juice, and cranberry juice.
Is warfarin a blood thinner?
Though it can be very helpful for some people, it does carry some risks. Drugs like warfarin are sometimes called “blood thinners.”. In reality, these drugs don’t really “thin” your blood, but they do make it less likely to clot. Coumadin and Jantoven are common brand names of the drug warfarin.
Why do people take warfarin?
Some people who take warfarin are at a higher risk of bleeding because their genetics make them more sensitive to the medication. Your doctor may recommend a genetic test to determine the best dose for you. Medical conditions that increase the risk of bleeding include: Uncontrolled blood pressure. A history of stroke.
What supplements interact with warfarin?
Ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, Naprelan, others) Medications that treat abnormal heart rhythms, such as amiodarone (Pacerone, Nexterone) Common supplements that can interact with warfarin include: Common foods and drinks that might interact with warfarin include:
What to do if you miss a dose of a sulfate?
If you miss a dose, take it as soon as you remember. If you don't remember until the next day, call your doctor for instructions. If your doctor isn't available, skip the missed dose and resume your normal dosing schedule. Never take a double dose. If you follow your doctor's dosing instructions and tell all your health care providers ...
What foods are good for warfarin?
Foods rich in vitamin K are green vegetables, including lettuce, spinach and broccoli. If you are taking warfarin, the amount of vitamin K in your diet may affect how well the medicine works. If you take warfarin, it's important to have a consistent amount of vitamin K in your diet. Too little vitamin K can increase your risk of bleeding.
What to use to prevent bleeding?
Use safer hygiene and grooming products. A soft-bristle toothbrush, waxed dental floss and an electric razor for shaving can help prevent bleeding.
How to protect yourself from a head injury?
Protect yourself from injury. Avoid contact sports or activities with a high risk of head injury. Wear a bicycle helmet. Tell your doctor if you are unsteady while walking or have a history of falling.
Can warfarin cause necrosis?
Head injury, even if you're not bleeding. Rarely, warfarin can cause the death of skin tissue (necrosis). This complication occurs within a few days of starting warfarin treatment. Seek immediate medical care if you notice any sores, changes in skin color or temperature, or severe pain on your skin.
Usual Adult Dose for Prevention of Thromboembolism in Atrial Fibrillation
Initial dose: 2 to 5 mg orally once a day Maintenance dose: 2 to 10 mg orally once a day Target INR: 2.5 (range: 2 to 3) Duration of therapy: Indefinite Comments: -For patients with atrial fibrillation (AF) and prosthetic heart valves, target INR may be increased depending on valve type, valve position, and patient factors. -Initial dose is influenced by age, race, body weight, gender, concomitant medications, comorbidities, genetic variation, and possibly other factors. -Dosage and administration must be individualized according to the patient's INR and condition being treated. Use: Prophylaxis and treatment of thromboembolic complications associated with AF..
Usual Adult Dose for Thromboembolic Stroke Prophylaxis
Initial dose: 2 to 5 mg orally once a day Maintenance dose: 2 to 10 mg orally once a day Target INR: 2.5 (range: 2 to 3) Duration of therapy: Indefinite Comments: -For patients with atrial fibrillation (AF) and prosthetic heart valves, target INR may be increased depending on valve type, valve position, and patient factors. -Initial dose is influenced by age, race, body weight, gender, concomitant medications, comorbidities, genetic variation, and possibly other factors. -Dosage and administration must be individualized according to the patient's INR and condition being treated. Use: Prophylaxis and treatment of thromboembolic complications associated with AF..
Usual Adult Dose for Myocardial Infarction
Initial dose: 2 to 5 mg orally once a day Maintenance dose: 2 to 10 mg orally once a day INR: 2 to 3 Duration of therapy: At least 3 months after myocardial infarction Comments: -Initial dose is influenced by age, race, body weight, gender, concomitant medications, comorbidities, genetic variation, and possibly other factors. -Dosage and administration must be individualized according to the patient's INR and condition being treated. Use: Reduction in the risk of death, recurrent myocardial infarction (MI), and thromboembolic events such as stroke or systemic embolization after myocardial infarction..
Usual Adult Dose for Myocardial Infarction - Prophylaxis
Initial dose: 2 to 5 mg orally once a day Maintenance dose: 2 to 10 mg orally once a day INR: 2 to 3 Duration of therapy: At least 3 months after myocardial infarction Comments: -Initial dose is influenced by age, race, body weight, gender, concomitant medications, comorbidities, genetic variation, and possibly other factors. -Dosage and administration must be individualized according to the patient's INR and condition being treated. Use: Reduction in the risk of death, recurrent myocardial infarction (MI), and thromboembolic events such as stroke or systemic embolization after myocardial infarction..
Usual Adult Dose for Deep Vein Thrombosis - Prophylaxis
Initial dose: 2 to 5 mg orally once a day Maintenance dose: 2 to 10 mg orally once a day Target INR: 2.5 (range: 2 to 3) Duration of therapy: -Deep venous thrombosis (DVT) or pulmonary embolism (PE) secondary to a reversible risk factor: 3 months -Unprovoked DVT or PE: At least 3 months; evaluate risk-benefit ratio of long-term treatment after 3 months. -Two episodes of unprovoked DVT or PE: Indefinite; periodically reassess risk-benefit ratio of continuing such treatment. Comments: -Initial dose is influenced by age, race, body weight, gender, concomitant medications, comorbidities, genetic variation, and possibly other factors. -Dosage and administration must be individualized according to the patient's INR and condition being treated. Use: Prophylaxis and treatment of venous thrombosis and PE..
Usual Adult Dose for Pulmonary Embolism
Initial dose: 2 to 5 mg orally once a day Maintenance dose: 2 to 10 mg orally once a day Target INR: 2.5 (range: 2 to 3) Duration of therapy: -Deep venous thrombosis (DVT) or pulmonary embolism (PE) secondary to a reversible risk factor: 3 months -Unprovoked DVT or PE: At least 3 months; evaluate risk-benefit ratio of long-term treatment after 3 months. -Two episodes of unprovoked DVT or PE: Indefinite; periodically reassess risk-benefit ratio of continuing such treatment. Comments: -Initial dose is influenced by age, race, body weight, gender, concomitant medications, comorbidities, genetic variation, and possibly other factors. -Dosage and administration must be individualized according to the patient's INR and condition being treated. Use: Prophylaxis and treatment of venous thrombosis and PE..
Usual Adult Dose for Deep Vein Thrombosis - First Event
Initial dose: 2 to 5 mg orally once a day Maintenance dose: 2 to 10 mg orally once a day Target INR: 2.5 (range: 2 to 3) Duration of therapy: -Deep venous thrombosis (DVT) or pulmonary embolism (PE) secondary to a reversible risk factor: 3 months -Unprovoked DVT or PE: At least 3 months; evaluate risk-benefit ratio of long-term treatment after 3 months. -Two episodes of unprovoked DVT or PE: Indefinite; periodically reassess risk-benefit ratio of continuing such treatment. Comments: -Initial dose is influenced by age, race, body weight, gender, concomitant medications, comorbidities, genetic variation, and possibly other factors. -Dosage and administration must be individualized according to the patient's INR and condition being treated. Use: Prophylaxis and treatment of venous thrombosis and PE..
What is the recommended dosage of phytomenadione for minor bleeding?
Anticoagulated patients who are experiencing minor bleeding should have their warfarin doses omitted and be given 2mg of oral phytomenadione. If the patient has a significantly high INR (above 8.0 for a patient with no risk factors for falls or haemorrhage) or is at risk of falling, he or she should be given 1-2mg of IV phytomenadione.
What is a thromboprophylaxis med?
They are used for several indications, including thromboprophylaxis for patients with atrial fibrillation, or who have undergone a mechanical heart valve replacement or had deep vein thrombosis (DVT). They are also used to treat current DVTs or pulmonary emboli.
Why is INR important?
Regardless of which treatment is used, it is important to increase the frequency of INR monitoring until it returns to the desired range.
What is the aim of treatment for haemorrhage?
The aim of treatment should be to arrest the haemorrhage as quickly as possible and stabilise the patient, thereby limiting further harm.
Can warfarin be reversed?
Clinicians also consider how quickly and to what extent the anticoagulation needs to be reversed. Any requirement for warfarin reversal therapy can serve as an opportunity to review whether warfarin treatment is still necessary for the patient .
Can vitamin K cause thrombosis?
Overenthusiastic use of vitamin K can cause warfarin resistance when anticoagulation is restarted, which exposes a patient to an increased risk of thrombosis. Before vitamin K is administered, the potential for warfarin resistance must be balanced against the risk of bleeding — determined according to the patient’s indication for anticoagulation.
Do pharmacists need to refer patients for warfarin reversal?
Nonetheless, pharmacists may need to refer patients for treatment to reverse over-anticoagulation, so a clear understanding of how such patients are managed is essential. It also helps to understand the subsequent care of patients who have undergone warfarin reversal treatment.
