Nurse’s Notes: Clinics can help with dosage
Between 2 million and 3 million Americans take warfarin (Coumadin) to prevent blood clot formation, which is important in various medical conditions such as atrial fibrillation or after certain procedures, such as getting a new heart valve. Blood levels of a person’s international normalized ratio are measured regularly, and doses of the medication are adjusted accordingly.
Warfarin management may seem overwhelming, but anticoagulation clinics are here to help. While it may not seem like a lot goes into dosing warfarin, more goes into it than may be obvious. Nurses work with people on warfarin, and we want folks who take it to understand they play an important role in the management of their dosing.
A health care provider will start a patient on warfarin for a number of reasons. Although warfarin increases the time the body takes to form blood clots, it is a safe medicine to take when monitored appropriately. Routine follow-up for INR checks is an extremely important part of warfarin management.
During follow-up appointments, nurses will assess numerous issues with regard to your warfarin management. They will check your INR and compare it against your weekly dosing schedule. An INR reading may be outside of the optimal range for something as simple as a missed dose. However, when a patient starts or discontinues a medication, is ill, has been hospitalized or is scheduled for surgery, warfarin dosing is likely to be effected and will need to be adjusted.
It is the job of the nurse in the anti-coagulation clinic to figure out what to do with the patient’s warfarin dosing and when to safely see the patient back in the clinic to help maintain that patient within their goal range. The job of the patient taking warfarin is to notify the nurse in the anti-coagulation clinic of any changes in their medical condition or lifestyle that will affect INR readings.
This may sound simple, but many common activities can impact an INR level. What a person eats and drinks, how much a person exercises or doesn’t, any over-the-counter medications, prescription medications or herbal supplements, illnesses, whether a person smokes or doesn’t, dieting and weight changes, surgery and recovering from surgery are some of the other causes that can change a person’s INR reading. Anything out of the norm for a patient needs to be reported to the nurse at the anti-coagulation clinic immediately.
Warfarin management does not have to be confusing for the patient; supportive and knowledgeable anti-coagulation nurses can help greatly. What the nurses want you to focus on is being consistent.
Be as consistent as you can with your diet and your activity. Don’t worry about avoiding certain foods with vitamin K – except green and white tea; those are the only no-nos. If you like salads and green vegetables, eat them; they offer great health benefits. However, they can affect your INR readings, so it is important to be consistent in the quantity and regularity with which you eat these foods. Let the nurses adjust your warfarin doses around you; don’t adjust your lifestyle around warfarin.
Keep your scheduled appointment times for INR follow-up and take your warfarin as directed. Contact the anticoagulation clinic before you change, start or stop taking other medications. Always watch for signs of bleeding and or unusual bruising.
By following these basic guidelines, patients taking warfarin can live healthy, stable lives with minimal disruption caused by this life-saving medication. While it seems complex, with the help of your anti-coagulation nurse you can keep it simple!
Christin Lulow is a registered nurse in the Coumadin clinic at the International Heart Institute at St. Patrick Hospital.