Who Should take Coumadin

The majority of individuals taking Coumadin fall into one of the categories below:

1)        One or more episodes of venous clotting in the leg or arm
2)        A heart condition such as abnormal rhythm or mechanical valve that predisposes to arterial clotting  (stroke or
heat attack)
3)        A genetic or acquired condition that predisposes to clotting in both veins and arteries

In all cases the occurrence of life threatening conditions if untreated is quite high. Therefore, taking Coumadin in almost
all cases is serious business. You’d do well to take it seriously and learn as much about it as possible. Despite being a life-
saver, Coumadin has a narrow therapeutic window. That means it can easily hurt you if you’re not monitoring its levels
and following the appropriate instructions in your daily habits and diet.  

How Coumadin Works

Within the human body there are two complimentary mechanisms for forming a clot, platelets and specialized liver
proteins. Platelets are small circulating cells in the blood. When there is bleeding anywhere in the body specialized proteins
in the blood are activated causing them to bind one another and to platelets thus forming a clot and stopping the bleeding.
Aspirin and anti-inflammatory medications retard the ability of platelets to congregate. Coumadin and other anticoagulants
retard the ability of the specialized proteins to become active. As a result conditions that require “thinning” the blood are
treated with either a medication that antagonizes the proteins or the platelets and almost never both.  
Unlike Aspirin, Coumadin does not exert its full activity for 3-4 days after you start the medication. The clotting proteins
that are made in the liver last for up to 5 days in circulation. Thus, every day approximately 20% of the circulating pool
of these proteins is made by the liver. The dose of Coumadin you take today will only affect 20-25% of the total amount
of these proteins in your system tomorrow and so on. This and other factors cause the dosing of Coumadin to be more
complicated and delicate than most other medications in use today.

Taking Coumadin

If you are taking Coumadin there are some general precautions you must always exercise in order to avoid suffering
complications of this therapy or the underlying medical condition.

1)        Take extra precautions with activities that may cause physical injury. People taking Coumadin are more likely to
have severe bleeding from simple cuts and nicks. So wear a helmet if you’re riding a bicycle, sailing or climbing.
2)        Take Coumadin at the same time every day, preferably at bedtime.
3)        Don’t take Coumadin with other medications or foods listed below that may interfere with its absorption.
4)        Tell any healthcare provider, therapist or practitioner of any kind that you see for any reason that you are taking
Coumadin.
5)        Wear a medical bracelet/necklace stating that you are on Coumadin in case there is an emergency.
6)        Avoid all over the counter medications for cold or pain unless specifically directed by a physician. In general
Tylenol, Ultram and Tylenol containing narcotic preparations such as Vicodin and Tylenol with Codeine are safe. Vioxx,
Bextra and Celebrex that are second generation anti-inflammatories are theoretically safe as they do not interfere with
platelet function but beware, experience is limited.
7)        Avoid all over the counter herbal preparations unless specifically directed by a physician. Many such preparations
include aspirin like substances that will predispose you to bleeding.
8)        If you forget a dose do not double up on the dose the next day. Stick to your regimen as directed the next day.  



Coumadin Diet

General Concepts:  Do not vary your intake of foods containing large amounts of vitamin K. These include leafy greens
and the outer peels of vegetables. Examples of some fods with medium content of vitamin K include asparagus,
avaocado, egg yokes, maragarine, olive oil, peas, pickles, red cabbage.  


Foods high in Vitamin K include:

Broccoli
Brussels sprouts
Cabbage
Chives
Collard greens
Endive
Lettuce
Liver
Mayonnaise
Mint
Mustard greens
Mustard
Oil, canola, soybean
Parsley
Seaweed
Scallions
Spinach
Teas containing sweet clover, woodruff and Tonka beans
Turnip
Watercress

Foods low in Vitamin K include:

Green Beans
Carrots
Cauliflower
Celery
Corn
Cucumbers (peeled)
Dairy products
Eggplant
Fresh fruits, most types
Honey
Meats, all types
Mushrooms
Oil, corn, peanut, sesame, sunflower
Onions
Pepper, green
Peanut butter
Potatoes
Pumpkin
Sauerkraut
Starch, rice/bread, pasta
Sugar
Tomato

Medications that can interfere with Coumadin increasing PT/INR or cause excess
bleeding by affecting platelets include:

Macrolides  (erythromycin, biaxin, zithromax)
TetracyclinesTMP/Sulfa (Bactrim)
Quinolones (Cipro, Levaquin,…)
Imidazoles (Diflucan, Itraconazole)Metronidazole


Amiodarone, Propafenone, Quinidine, Digoxin
Tylenol (generally accepted as safest analgesic)
NSAID’s
Statins, Lipitor, Zocor, Crestor,…
Valproic Acid
HaldolSertraline
Beta blockersMethyldopaEthacrynic Acid
Prilosce, PrevacidNexium
Thyroid Hormone
Herbal based pain medications

Medications that can interfere with coumadin and make it less effective by decreasing
PT/INR include:

Rifampin
Nafcillin
DicloxicillinGriseofulvin

Cox 2 inhibitors

CarbamazepineBarbituates
Trazadone
Aldactone
SucralfateCalcium based antacids
Propylthiouracil
Multi-vitamins with vitamin K
Ensure, boost, other vitamin K containing agents