FAQ’S ABOUT COUMADIN/WARFARIN/JANTOVEN
1). WILL I NEED TO CHECK ANY BLOOD WORK WHILE TAKING COUMADIN, AND IF SO, HOW OFTEN?
While taking coumadin, it is necessary to check your Protime/INR level at least monthly when taking coumadin. When first starting coumadin, if your levels are out of your target range, or if you have special needs, you will need to check your Protime/INR level more often. Coumadin dosing is determined by your INR level. The levels should be checked as directed by your physician, to avoid any problems with your bloods clotting ability.
2). WHAT IS A TARGET RANGE?
A target range is established by the physician and will vary from person to person, depending upon the diagnosis. Your INR level should be within the prescribed range. If it is lower than the range, your blood is too “thick” and if it is over the range, it is too “thin.” If the INR is within the range, it is right on target. Sample ranges include 2.0-3.0, 2.5-3.5, 3.0-4.0, as well as many others. The terms “thick” and “thin” are used to describe the bloods ability to form clots. Thicker blood forms clots faster, and thinner blood takes longer to form clots.
3). WILL I NEED TO MAKE CHANGES TO MY DIET WHILE ON COUMADIN?
The biggest change in your diet will come from your need to be consistent with foods. Vitamin K is the nutrient found in foods that affect Coumadin and Protime/INR levels. Foods that are high in Vitamin K, have a direct effect on your INR and make the blood “thicker.” These foods include green vegetables (lettuce, broccoli, spinach, peas, etc), and certain oils (soybean, canola). The only meat rich in Vitamin K is liver. Click Here For Vitamin K Chart. When choosing foods high in Vitamin K, try to eat a consistent number of servings per week and try to eat the same serving sizes. Being consistent is the best way to keep your bloodwork steady. Greens are an important part of your nutritional intake and omitting them is not the best option. Just be consistent. Also a drop or increase in appetite, or a change in eating while you are sick will affect your Protime/INR. Please notify us if there are any changes in your diet, and ask your Protime Nurse if you have any questions regarding food intake.
4). CAN I DRINK ALCOHOL WHILE TAKING COUMADIN?
Drinking alcohol is not recommended while taking coumadin, because it has a profound effect on your Protime/INR and is very risky. If, regardless of the risk, you do choose to have alcoholic beverages while taking coumadin, it is imperative to be consistent with this, and avoid more than 1-2 drinks per day, and avoid binge drinking. Alcohol intake causes sudden and unexpected rises in Protime/INR levels and can result in serious and unexpected bleeding problems.
5). WHAT SHOULD I DO IF ANOTHER PHYISCIAN PRESCRIBES A NEW MEDICATION FOR ME OR I CHOOSE TO TAKE OVER THE COUNTER MEDICATIONS?
Please call us whenever there is a change in your medications. Many medications, including antibiotics, steroids, cholesterol medications, etc will affect your INR level. It is important that your Protime/INR level is monitored closely during this time, and your Protime Nurse will give you specific instructions.
6). ARE THERE ANY OVER THE COUNTER MEDICATIONS THAT I CAN USE FOR PAIN RELIEF OR STOMACH UPSET?
When choosing an over the counter pain reliever, acetaminophen is the best choice, unless you are allergic or have problems with your liver. Aspirin, ibuprofen or naproxen will affect your INR. When choosing a medication for your stomach, avoid the pink bismuth preparations (pepto-bismol, etc), as they will also increase your Protime/INR. Liquid antacids are safe to use with coumadin. Please discuss all medications or any questions about over the counter medications with your physician or the Protime Nurse.
7). WHAT SHOULD I DO IF I CUT MYSELF OR START BLEEDING?
For any severe bleeding problems always use the emergency room or call 911 if appropriate. For any bleeding/bruising problems, notify us and prepare to have your Protime/INR level checked. Your Protime Nuse can provide you with appropriate instructions.
8). WHAT SHOULD I DO IF I FALL AND HIT MY HEAD OR INJURE MYSELF?
Head injuries should be evaluated by an emergency room physician, even if you do not have any symptoms. Head injures can be serious and bleeding can occur without symptoms. Please use 911, if appropriate, and use the emergency room. Contact our office and let us know whenever you are injured.
9). WHAT IF I NEED SURGERY OR DENTAL WORK?
Please contact your Protime Nurse whenever procedures are planned. We will provide instructions about how to safely discontinue your coumadin and determine, through your physician, if any additional medications will be needed. Coumadin does not need to be discontinued for dental cleanings or for some minor surgical procedures. We will work with your surgeon/dentist if there are any questions.
10). IF I AM PLANNING A VACATION OR TRIP OUT OF TOWN, HOW WILL I HAVE MY BLOOD DRAWN?
When traveling, the Protime Nurses can provide you with a special “standing order” to take with you on your trip. If you have a cell phone or other contact number, please provide that to the Protime Nurse. Call your insurance company to ask about drawing facilities out of town. Take your standing order to the appropriate lab, and obtain the phone number to the laboratory while having your blood drawn there. Draw your blood early in the morning if possible. We will call your INR back to you, if we have a contact number, or if not, please call us later that day, or next day for the result. If we have not received the result yet, we will use the laboratory’s phone number to obtain the result for you. Our toll free number is 1-800-243-1912.
11). WHAT SHOULD I DO IF I HAD MY BLOOD DRAWN AND I HAVE NOT HEARD FROM YOUR OFFICE?
If you do not hear from our office within 48 hours, please call us. We attempt to call everyone as soon as their results are available, but due to occasional high volumes, it may take longer. Critically abnormal results will be called immediately upon their receipt from the lab. Please do not skip your Coumadin dose if you have not heard from us. Please continue the same dose until you receive the result.
12). WHEN IS THE BEST TIME OF DAY TO TAKE MY COUMADIN?
Taking your coumadin in the evening, between supper and bedtime, is the best way for us to manage your coumadin. It may be taken along with other meds, and with or without food. If you have trouble remembering to take your medication, use a pill box with a spot for each day of the week and keep it in a central location where you will see it. Any questions, please ask your Protime Nurse.
13). WHEN IS THE BEST TIME TO DRAW MY BLOOD?
Drawing your Protime/INR earlier in the morning allows us to get the results back faster, and if abnormal, allows us to call us sooner. Try to draw your lab before 11am if possible. Also try to avoid drawing labs on Fridays, due to large volumes of results coming in, and the office being closed on Saturday and Sunday, which will cause a delay in your result.
14). WHAT IF I BECOME PREGNANT?
Please call us as soon as you know that you are, or might be, pregnant. Coumadin can have an effect on your baby.
15). WHEN ARE THE PROTIME NURSES IN THE OFFICE AND HOW CAN I REACH THEM?
The Protime Nurses are in the office from 8:00 to 4:30 Monday through Friday. Voice mail and email are available for your use during heavy call volumes. Please do not leave urgent messages on the voice mail. The nurses will try to respond to your message within 24 hours. For urgent calls, please wait to speak with the nurse.