More serious bleeding events such as a hemorrhagic stroke, where a blood vessel bursts or weakens and bleeds into the brain, are life-threatening.
The annual risk of major bleeding in the brain or bleeding requiring transfusion or hospitalisation has ranged between 1. Identifying factors for bleeding risk is key to preventing complications with warfarin. Behavioural and lifestyle factors can also play a role, as you need to monitor your diet for vitamin K and alcohol intake.
Psychological and social factors, such as low mood and poor warfarin education — together with how your warfarin is monitored, managed and administered — can increase your risk. This makes warfarin a very complex medication. On the other, these known risk factors can influence warfarin stability and have resulted in under-use of warfarin in those most at risk of stroke, the elderly.
But these anticoagulants come with their own challenges. There is no quick and easy antidote and there are concerns about their management and effectiveness within a complex and ageing population in long-term therapy. Festival of Social Science — Aberdeen, Aberdeenshire. Therefore, patients who fill U. We advise U. Foreign drugs may use identical or potentially confusing brand names for products with active ingredients that differ from U. Warfarin has many foreign brand names Table 1.
Patients who do fill prescriptions abroad should ensure the accuracy and quality of the medication dispensed. Never increase or decrease your dose unless instructed to do so by your healthcare provider. If a dose is missed or forgotten, call your healthcare provider for advice. The major complications associated with warfarin are clotting due to underdosing or bleeding due to excessive anticoagulation. The most serious bleeding is gastrointestinal or intracerebral. Excessive bleeding can occur in any area of the body, and patients taking warfarin should report any falls or accidents, as well as signs or symptoms of bleeding or unusual bruising, to their healthcare provider.
An unusual headache or a headache that is more severe than usual may signal intracerebral bleeding. If you experience the following signs of bleeding, you should call or your healthcare provider immediately:. Some simple changes to decrease the risk of bleeding while taking warfarin include the following:. Changes in daily living can affect the INR. Warfarin is not recommended during pregnancy. A woman who becomes pregnant or plans to become pregnant while undergoing warfarin therapy should notify her healthcare provider immediately.
It is important to tell all your healthcare providers that you are taking warfarin. If you are having surgery, dental work, or other medical procedures, you may need to stop taking warfarin. Check with your healthcare provider if you expect to travel. While traveling, it is important to carry your medication with you at all times. Do not put medication into checked baggage. Patients who take warfarin should consult with their healthcare provider before taking any new medication, including over-the-counter nonprescription drugs, herbal medicines, vitamins or any other products.
Many medications can alter the effectiveness of warfarin, resulting in an INR that is either too high or too low. Warfarin On this page About warfarin Key facts Who can and can't take warfarin How and when to take it Bleeding and what to do about it Other side effects How to cope with side effects Advice about food and drink Pregnancy and breastfeeding Cautions with other medicines Common questions.
About warfarin Warfarin is a type of medicine known as an anticoagulant, or blood thinner. Warfarin is used to treat people who have had a previous blood clot, such as: a blood clot in the leg deep vein thrombosis, or DVT a blood clot in the lungs pulmonary embolism It's also used to prevent blood clots if you're at high risk of having them in the future.
This includes people with: an abnormal heartbeat atrial fibrillation a replacement or mechanical heart valve a blood clotting disorder, such as thrombophilia a higher chance of having a blood clot after an operation Warfarin is only available on prescription.
NHS coronavirus advice When taking warfarin, you need to have regular blood tests. Updated: 15 October Help us improve our website Can you answer a quick question about your visit today? It's usual to take warfarin once a day, normally in the evening. The main side effect of warfarin is bleeding more easily than normal, such as having nosebleeds, bleeding gums, heavier periods and bruising. This is most likely to happen in the first few weeks of treatment or if you're unwell. You need to have blood tests at least every 12 weeks while you're taking warfarin to make sure your dose is right.
Expect your warfarin dose to go up or down. This is normal. The dose can depend on lots of different things, including what you eat and drink, what other medicines you're taking, and if you become unwell. Always carry your anticoagulant alert card with you. Show it to your doctor or dentist before you have any medical or dental procedures, including vaccinations and routine appointments with the dental hygienist.
Warfarin can be taken by adults and children. Warfarin is not suitable for some people. Tell your doctor if you: have had an allergic reaction to warfarin or any other medicines in the past are trying to get pregnant or you're already pregnant - warfarin can be harmful to the baby have liver or kidney problems have had an infection of the lining of your heart known as endocarditis have a health problem that causes bleeding such as a stomach ulcer or makes you bruise easily have high blood pressure are taking the herbal remedy St John's wort for depression.
Dosage and strength The usual warfarin dose is 10mg a day for the first 2 days, then between 3mg and 9mg a day after that.
The strengths and colours are: 0. How to take it It's very important to take warfarin as your doctor advises. How long to take it for If you have had a blood clot in your leg or lungs, you'll probably take a short course of warfarin for 6 weeks to 6 months.
Will my dose go up and down? Why do I have blood tests? The yellow book and alert card When you start taking warfarin, you may be given a yellow book about anticoagulants. Example of front of anticoagulant alert card. Example of back of anticoagulant alert card. What if I forget to take it? It's important to try to remember to take your warfarin on time.
If you miss a dose of warfarin, write it down in your yellow book. Take the missed dose as soon as you remember. Never take more than 1 dose a day. If you often forget doses, it may help to set an alarm to remind you. If you're worried, contact your anticoagulant clinic or doctor. What if I take too much? You may need to change your next dose of warfarin or have a blood test.
Less serious bleeding It's usual to bleed more easily than normal while you're taking warfarin. The kind of bleeding you might have includes: periods that are heavier and last longer than normal bleeding for a little longer than usual if you cut yourself occasional nosebleeds that last for less than 10 minutes bleeding from your gums when you brush your teeth bruises that come up more easily and take longer to fade than usual This type of bleeding is not dangerous and should stop by itself.
Things you can do to help yourself Cuts press on the cut for 10 minutes with a clean cloth. Nosebleeds — find out how to stop a nosebleed or watch this video on nosebleeds. Bleeding gums — if your gums are bleeding, try using a soft toothbrush and waxed dental floss to clean your teeth. Bruises — these are harmless, but can be unsightly. It might help to make them fade more quickly if you put an ice pack wrapped in a towel over the bruise for 10 minutes at a time several times a day.
What you can do to prevent bleeding While you're taking warfarin, be careful when you do activities that might cause an injury or a cut or bruising. It can help to: stop playing contact sports or other activities than can cause a head injury, such as football, rugby, hockey and horse riding wear gloves when you use sharp objects like scissors, knives and gardening tools stop wet shaving or removing hair with wax - use an electric razor or hair-removing cream instead take false teeth dentures or retainers out for a few hours a day, if you wear them, to give your gums a rest — do not wear dentures or retainers that do not fit properly tell your doctor, dentist or nurse that you take warfarin ahead of having any medical or dental procedures or surgery - that includes vaccinations and routine appointments with the dental hygienist Serious bleeding Occasionally, you can have serious bleeding from taking warfarin.
This can be dangerous and needs urgent medical attention. You have red pee or black poo large bruises or bruises that happen for no reason nosebleeds that last longer than 10 minutes blood in your vomit or you're coughing up blood severe headaches, fits or seizures, changes to your eyesight, numbness or tingling in your arms or legs, or feel very tired, weak or sick — these can be signs of bleeding in your brain any bleeding from a cut or injury that will not stop or slow down These are symptoms of serious bleeding.
If you have serious bleeding, stop taking warfarin. Common side effects These side effects are usually mild, but talk to your doctor or pharmacist if these symptoms bother you or do not go away: a mild rash hair loss Serious side effects Call a doctor straight away if you develop any of these serious side effects: yellowing of your skin and dark urine - these can be signs of liver problems painful and swollen patches on your skin severe headaches, fits or seizures, changes to your eyesight, numbness or tingling in your arms or legs, or feeling very tired, weak or sick — these can be signs of bleeding in your brain Serious allergic reaction In rare cases, warfarin can cause a serious allergic reaction anaphylaxis.
Information: You can report any suspected side effect using the Yellow Card safety scheme. Visit Yellow Card for further information. What to do about: a mild rash — it may help to take an antihistamine, which you can buy from a pharmacy. Check with the pharmacist to see what type is suitable for you. If the rash does not go away within a few days, speak to your doctor. These include: green leafy vegetables, including broccoli, spinach and lettuce chickpeas liver egg yolks wholegrain cereals mature cheese and blue cheese avocado olive oil It's important that you eat foods containing vitamin K, so rather than leaving them out of your diet, make sure you eat similar amounts of them regularly.
Warfarin is not normally recommended during pregnancy. The upper heart chambers atria beat in a disorganized way and cause rapid, irregular heartbeats. This causes the blood to pool, which may allow a clot to form. If these clots break loose, they may travel to the brain and cause a stroke. A stroke is caused by a blood clot that forms in the brain. This may also be caused by another material emboli moving through the blood that goes to the brain.
Artificial or mechanical heart valves are very useful in replacing bad heart valves.
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