Anticoagulation, Generic

Anticoagulants are medications used to prevent clots from developing in your veins. These medications are also known as blood thinners. If blood clots are untreated, they could travel to your lungs. This is called a pulmonary embolus. A blood clot in your lungs can be fatal.

Caregivers often use anticoagulants to prevent clots following surgery. Anticoagulants are also used along with aspirin when the heart is not getting enough blood.

Another anticoagulant called warfarin is started 2 to 3 days after a rapid-acting injectable anticoagulant is started. The rapid-acting anticoagulants are usually continued until warfarin has begun to work. Your caregiver will judge this length of time by blood tests known as the prothrombin time (PT) and International Normalization Ratio (INR). This means that your blood is at the necessary and best level to prevent clots.

RISKS AND COMPLICATIONS

  • If you have received recent epidural anesthesia, spinal anesthesia, or a spinal tap while receiving anticoagulants, you are at risk for developing a blood clot in or around the spine. This condition could result in long-term or permanent paralysis.

  • Because anticoagulants thin your blood, severe bleeding may occur from any tissue or organ. Symptoms of the blood being too thin may include:

  • Bleeding from the nose or gums that does not stop quickly.

  • Unusual bruising or bruising easily.

  • Swelling or pain at an injection site.

  • A cut that does not stop bleeding within 10 minutes.

  • Continual nausea for more than 1 day or vomiting blood.

  • Coughing up blood.

  • Blood in the urine which may appear as pink, red, or brown urine.

  • Blood in bowel movements which may appear as red, dark or black stools.

  • Sudden weakness or numbness of the face, arm, or leg, especially on one side of the body.

  • Sudden confusion.

  • Trouble speaking (aphasia) or understanding.

  • Sudden trouble seeing in one or both eyes.

  • Sudden trouble walking.

  • Dizziness.

  • Loss of balance or coordination.

  • Severe pain, such as a headache, joint pain, or back pain.

  • Fever.

  • Too little anticoagulation continues to allow the risk for blood clots.

HOME CARE INSTRUCTIONS

  • Due to the complications of anticoagulants, it is very important that you take your anticoagulant as directed by your caregiver. Anticoagulants need to be taken exactly as instructed. Be sure you understand all your anticoagulant instructions.

  • Warfarin. Your caregiver will advise you on the length of treatment (usually 3–6 months, sometimes lifelong).

  • Take warfarin exactly as directed by your caregiver. It is recommended that you take your warfarin dose at the same time of the day. It is preferred that you take warfarin in the late afternoon. If you have been told to stop taking warfarin, do not resume taking warfarin until directed to do so by your caregiver. Follow your caregiver's instructions if you accidentally take an extra dose or miss a dose of warfarin. It is very important to take warfarin as directed since bleeding or blood clots could result in chronic or permanent injury, pain, or disability.

  • Too much and too little warfarin are both dangerous. Too much warfarin increases the risk of bleeding. Too little warfarin continues to allow the risk for blood clots. While taking warfarin, you will need to have regular blood tests to measure your blood clotting time. These blood tests usually include both the PT and INR tests. The PT and INR results allow your caregiver to adjust your dose of warfarin. The dose can change for many reasons. It is critically important that you take warfarin exactly as prescribed, and that you have your PT and INR levels drawn exactly as directed. Follow up with your laboratory test appointments as directed. It is very important to keep your lab appointments. Not keeping lab appointments could result in a chronic or permanent injury, pain, or disability.

  • Many foods, especially foods high in vitamin K can interfere with warfarin and affect the PT and INR results. Foods high in vitamin K include spinach, kale, broccoli, cabbage, collard and turnip greens, brussels sprouts, peas, cauliflower, seaweed, and parsley as well as beef and pork liver, green tea, and soybean oil. You should eat a consistent amount of foods high in vitamin K. Avoid major changes in your diet, or notify your caregiver before changing your diet. Arrange a visit with a dietitian to answer your questions.

  • Many medicines can interfere with warfarin and affect the PT and INR results. You must tell your caregiver about any and all medicines you take, this includes all vitamins and supplements. Ask your caregiver before taking these. Prescription and over-the-counter medicine consistency is critical to warfarin management. It is important that potential interactions are checked before you start a new medicine. Be especially cautious with aspirin and anti-inflammatory medicines. Ask your caregiver before taking these. Medicines such as antibiotics and acid-reducing medicine can interact with warfarin and can cause an increased warfarin effect. Warfarin can also interfere with the effectiveness of medicines you are taking. Do not take or discontinue any prescribed or over-the-counter medicine except on the advice of your caregiver or pharmacist.

  • Some vitamins, supplements, and herbal products interfere with the effectiveness of warfarin. Vitamin E may increase the anticoagulant effects of warfarin. Vitamin K may can cause warfarin to be less effective. Do not take or discontinue any vitamin, supplement, or herbal product except on the advice of your caregiver or pharmacist.

  • Alcohol can change the body's ability to handle warfarin. It is best to avoid alcoholic drinks or consume only very small amounts while taking warfarin. Notify your caregiver if you change your alcohol intake. A sudden increase in alcohol use can increase your risk of bleeding. Chronic alcohol use can cause warfarin to be less effective.

  • If you have a loss of appetite or get the stomach flu (viral gastroenteritis), talk to your caregiver as soon as possible. A decrease in your normal vitamin K intake can make you more sensitive to your usual dose of warfarin.

  • Some medical conditions may increase your risk for bleeding while you are taking warfarin. A fever, diarrhea lasting more than a day, worsening heart failure, or worsening liver function are some medical conditions that could affect warfarin. Contact your caregiver if you have any of these medical conditions.

  • Warfarin can have side effects, such as excessive bruising or bleeding. You will need to hold pressure over cuts for longer than usual.

  • Be careful not to cut yourself when using sharp objects.

  • Notify your dentist or other caregivers before procedures.

  • Limit physical activities or sports that could result in a fall or cause injury. Avoid contact sports.

  • Wear a medical alert bracelet or carry a medical alert card.

SEEK MEDICAL CARE IF:

  • You develop any rashes.

  • You have any worsening of the condition for which you are receiving anticoagulation therapy.

SEEK IMMEDIATE MEDICAL CARE IF:

  • Bleeding from the nose or gums does not stop quickly.

  • You have unusual bruising or are bruising easily.

  • Swelling or pain occurs at an injection site.

  • A cut does not stop bleeding within 10 minutes.

  • You have continual nausea for more than 1 day or are vomiting blood.

  • You are coughing up blood.

  • You have blood in the urine.

  • You have dark or black stools.

  • You have sudden weakness or numbness of the face, arm, or leg, especially on one side of the body.

  • You have sudden confusion.

  • You have trouble speaking (aphasia) or understanding.

  • You have sudden trouble seeing in one or both eyes.

  • You have sudden trouble walking.

  • You have dizziness.

  • You have a loss of balance or coordination.

  • You have severe pain, such as a headache, joint pain, or back pain.

  • You have a serious fall or head injury, even if you are not bleeding.

  • You have an oral temperature above 102° F (38.9° C), not controlled by medicine.

ANY OF THESE SYMPTOMS MAY REPRESENT A SERIOUS PROBLEM THAT IS AN EMERGENCY. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in U.S.). DO NOT drive yourself to the hospital.

MAKE SURE YOU:

  • Understand these instructions.

  • Will watch your condition.

  • Will get help right away if you are not doing well or get worse.