What patients should know about warfarin

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It’s funny how conversations take bunny trails sometimes. Just the other day, an old friend of mine and I were talking about where to get the best deals on Christmas wrapping paper (we were torn between Walmart and the Dollar Tree) and the next thing I know we’re talking about blood thinners. What?

Actually, we were discussing warfarin (brand names Coumadin or Jantoven) which really isn’t a blood thinner because it doesn’t actually thin the blood. Warfarin causes the blood to take longer to form a clot. However, it’s is called an anticoagulant which means “blood thinner.” Got it?

Anyway, my friend was complaining that she was going to have to go to Coeur d’Alene the next day to have her blood tested and she had so much to do to get ready for her family coming for Christmas, blah, blah, blah…

I stopped her mid-sentence and told her to tell her physician that she can have the tests done right here. Really? Yes. Bonner General Health opened the Anticoagulation Clinic at the hospital just about two years ago now.

“The purpose of the Anticoagulation Clinic is to provide safe, effective management of anticoagulation therapy on an outpatient basis,” BGH’s website says. “Individuals respond differently to anticoagulation medication. It is necessary to monitor each patient to make sure they are at safe and therapeutic levels.

“At the ACC, you will receive quality, individualized care by a team of pharmacists that are committed to improving the management of your anticoagulation therapy,” BGH says.

“What would you rather do?” I asked my friend. “Drive an hour to Coeur d’Alene to spend twenty minutes, at most, at the clinic and then drive another hour home? Especially now that it’s winter? Yeah, I thought so.” If it hadn’t been a Sunday evening she would have called her physician right then.

As I already said, warfarin is about decreasing the clotting tendency of blood, not stopping it; ergo you need to have regular blood testing.

“On the basis of the results of the blood test, your daily dose of warfarin will be adjusted to keep your clotting time within a target range,” explains the American Heart Association. “The blood test used to measure the time it takes for blood to clot is referred to as a prothrombin time test, or Protime (PT). The PT is reported as the International Normalized Ratio (INR).

“The INR is a standardized way of expressing the PT value. The INR ensures that PT results obtained by different laboratories can be compared. It is important to monitor the INR (at least once a month and sometimes as often as twice weekly) to make sure that the level of warfarin remains in the effective range,” AHA says.

BGH’s Anticoagulation Clinic is staffed by pharmacists who are trained in anticoagulation therapy. This therapy not only includes monitoring and managing the medication but will also advise you about “your diet, effects illness can have, safety behaviors, possible interaction between warfarin and other medications, vitamins and herbal remedies,” the website explains.

Taking warfarin is more than just popping a pill every day. You may need to adjust your eating habits.

There is no diet per se, but certain foods and beverages alter the drug’s efficacy.

For instance, vitamin K may lessen warfarin’s effectiveness. The Mayo Clinic explains that “the adequate intake level of vitamin K for adult men is 120 micrograms (mcg). For adult women, it’s 90 mcg. While eating small amounts of foods that are rich in vitamin K shouldn’t cause a problem, avoid consuming large amounts of kale, spinach, Brussels sprouts, parsley, collard and mustard greens, chard and green tea.”

They also point out that drinking certain beverages can increase the effects of warfarin, leading to bleeding problems. They list cranberry juice and alcohol as drinks you should avoid or only consume in small quantities.

The professionals at the ACC will guide you through all the dos and don’ts and the best part is that it is right here in Sandpoint. The clinic is located in the new BGH building at 423 N. Third Ave., Suite 110. The hours are Monday through Wednesday, 7:30 a.m. to 5 p.m.

Kathy Hubbard is a member of Bonner General Health Foundation Advisory Council. She can be reached at 208-264-4029 or kathyleehubbard@yahoo.com.

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