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Coumadin®–to clot, or not to clot
03/29/2006
Sometimes you want your blood to clot—like when you scrape your knee or cut your finger. After a heart attack, however, the last thing you want is for a dangerous clot to form in your heart. Depending on the size and location, a clot can increase your risk of having another heart attack or stroke.

To slow down blood clotting in heart patients, doctors often will prescribe a drug called warfarin, also known by the trade name Coumadin®. If you have a condition such as atrial fibrillation (abnormal heart rhythm) or heart failure, or have an artificial valve or a history of clots, then chances are your doctor has prescribed Coumadin® for you.

Emily Ridley, a pharmacist with the Palmetto Health Internal Medicine Coumadin® Clinic, says patients on this drug must be monitored on a regular basis. In fact, it’s part of the follow-up treatment recommended by their doctors to monitor their blood, determine how the patient is responding to Coumadin® and, if necessary, make adjustments to the dosage. And that, says Ridley, can be a tricky thing. “A dosage of Coumadin® is not based on a person’s size and age, like many other drugs,” she says. “Each person responds differently to the medication so the dosage varies. It may take awhile for the body to stabilize itself on the right level.” Lab results and discussions with patients help determine the optimal dose.

Patients who have just begun taking warfarin visit the clinic a couple of times a week until their body stabilizes on a certain dose. Eventually, the patient visits on a monthly basis.

It’s critical to closely monitor the patient’s bloodwork because of the potential side effects such as abnormal bleeding problems. Also, there are quite a few food interactions patients must be aware of and monitor.

To prevent food interactions, patients must follow a consistent heart-healthy diet. Foods high in Vitamin K such as leafy greens, broccoli and Brussels sprouts must be eaten consistently.

“The key is to not suddenly change your diet,” says Ridley. “Have a few servings a week of a new food, if you want. Keep the amounts and types of foods you eat the same from week to week. Drastic changes can be harmful.” Ridley adds that patients should avoid fried foods and alcohol.

Drugs also interact with Coumadin®. Even over-the-counter products like aspirin and herbal supplements can cause serious problems such as internal bleeding. Other physical conditions also can cause unwanted interactions with Coumadin®.

The best way to minimize side effects is knowledge, says Ridley. “When you go to your Coumadin® Clinic, take time to ask questions. When you go to pick up your prescriptions, talk with your pharmacist. Being aware of your body and following your doctor’s instructions can help protect you from complications, damaging blood clots, heart attacks and strokes.”

What exactly is Coumadin®?
Coumadin®, a prescription drug called an anticoagulant, slows down the ability of blood to clot. Blood clots can be harmful, increasing the risk of heart attack or stroke. Coumadin®, also sold under the generic name warfarin, is the most widely used anti-clotting drug.