Coumadin “Watch Dog”

Let me give you a little background on myself.  I am a Cardiac nurse and I used to manage over 600 Coumadin patients.  I have run into a number of different situations that can be frightening for some of you.  I would like to share some tips on things you should be aware of while taking Coumadin.  I have been asked a number of questions on different forums and therefore, I decided maybe it would be beneficial to share these with you.  Before I begin, this is not meant to take the place of your managing physician, nurse or other, it is to help educate you.  If you have questions, you may leave me a comment and I will try to answer you as soon as I can because I dont believe I can place my email address on this blog.

1.  If you have been placed on Coumadin — make sure there is “1″ office managing you.

2.  Every one should have their PT/INR checked at least “once a month” – sometimes if you are not in range, it will require you to be checked more frequently.

3.  After every blood test, you should receive your result- instructions on your dose to take – and be told when you need to have your lab work repeated.

4.  Keep a Log of your results and the dose you were taking – this is important.

5.  Do not change your eating habits while on Coumadin – if you want to go on a diet and plan to eat more vegetables, make your managing physician aware of this – they will need to monitor your PT/INR

6.  Also, if you are sick and are placed on an antibiotic, cold medicine, steroid, etc – your doctor NEEDS to know–many medications and herbal supplements can interfere with the way Coumadin is processed – which can lead to a drop in INR or a rise.

7.  Although there is a risk taking Coumadin – the risk of not taking it is greater.  If you are educated on the things you as a patient need to be aware of, you can rest that developing a serious complication will be low.  Alot of people have asked about “bleeds” and the risk of dying because of Coumadin.  Out of the 600 patients that I managed, only 1 person died of a bleed – which was not diagnosed with certainty that it was caused by the Coumadin.  You do need to be aware that if you should have any blood in your urine, stool, or cough up blood, you should notify your physician immediately.  This is not to say it is always related to Coumadin. 

8.  There are very few side effects that I have seen with my patients on Coumadin.  The most common was:  nosebleeds.  In case of a nosebleed, you should squeeze the tip of your nose very tightly for 10 mins without letting go – if it does not stop – do this once more.  If your nose continues to bleed, you should consult your doctor because you may need to have your PT/INR checked and possibly have your nose cauterized.  Most of the time, this is due to all the tiny blood vessels you have in your nose that are close to the surface and sometimes harder to stop.  Many people read the side effects of Coumadin and because of their fear of taking it, cause themselves to become very anxious – which can cause some symptoms unrelated to Coumadin.  Not to say that no one will ever be the rare case – I know to never say never.

9.  Making adjustments to your Coumadin requires your doctor or nurse to “take their time” and look at you as an individual — it is important to look at your previous PT/INR and dosages.  While saying this, it is so important that you never allow any other doctor to give you instructions on stopping your Coumadin etc.  Always share with that doctor that you will need to consult with your managing doctor to see if it is okay to be off your Coumadin for a time.  I say this because: if you are taking Coumadin – it is critical for some diagnoses to not stop your Coumadin – sometimes you may be required to take a medication called Lovenox- this medication works a little differently than Coumadin – it is an injection that is taken twice a day – this drug can give you protection while being off the Coumadin and is used to protect you once you are started back up on your Coumadin until you are once again in your normal range.

**These are some tips for now – if you have further questions, please let me know, I am always willing to assist you or answer your questions if I can.  Please once again – I am not here to diagnose, treat, or take the place of your doctor.  If I have shared information that you were unaware of, you can always ask your doctor too.