Warfarin Coagulopathy

Warfarin (Coumadin®) coagulopathy refers to bleeding that may occur as a complication of the medication warfarin. Warfarin is an oral blood thinner (anticoagulant). Warfarin is used for many problems where thinning of the blood is needed to prevent blood clots. It usually takes 3 to 4 days of treatment with warfarin for the blood to be thinned to the target range. Blood tests will be done routinely to measure how fast your blood clots. The results of the blood tests will help determine your anticoagulant dose.

Every medication has potential side effects or complications. Bleeding is the most common and most serious complication of warfarin. The amount of bleeding may be related to the dose of warfarin, the length of treatment, diet, underlying medical conditions, and the use of other medications or supplements.

CAUSES

  • Intentional or accidental overdose.

  • Medication, herbal, supplement, or alcohol interactions.

  • Dietary changes.

  • Underlying medical conditions.

SYMPTOMS

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.

HOME CARE INSTRUCTIONS

  • Follow up with your laboratory test and caregiver appointments as directed. It is very important to keep your appointments. Not keeping appointments could result in a chronic or permanent injury, pain, or disability.

  • Do not resume taking warfarin until directed to do so by your caregiver. 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 your warfarin in the evening. This allows you to get your laboratory test results and if necessary, adjust your warfarin dose in a timely manner. 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.

  • Some foods interfere with the effectiveness of warfarin. Eating large amounts of foods high in vitamin K can cause warfarin to be less effective. Changing to a diet low in foods containing vitamin K may lead to an excessive warfarin effect. Eat what you normally eat and keep the vitamin K content of your diet consistent. Consult your caregiver before making major dietary changes.

  • 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. Consult your caregiver before changing or taking a new vitamin, supplement, or herbal product.

  • Several medications interfere with the effectiveness of warfarin. Pain relieving medications, antibiotics, and medications that decrease stomach acid are examples of some medications that can lead to an excessive warfarin effect. Warfarin may also interfere with the effectiveness of your other medicines. Consult your caregiver before stopping, changing, or taking new medications.

  • 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.

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

  • Avoid heavy or variable alcohol use. Consume alcohol only in very limited quantities. General alcohol intake guidelines are 1 drink for women and 2 drinks for men per day. (1 drink = 5 ounces of wine, 12 ounces of beer, or 1½ ounces of liquor). A sudden increase in alcohol use can increase your risk of bleeding. Chronic alcohol use can cause warfarin to be less effective.

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

  • Inform all your caregivers and your dentist that you take warfarin.

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.