Warfarin Education | Counselling Information

Warfarin Use / Purpose
Patient should be well educated regarding warfarin before starting the therapy. Warfarin is a blood thinning agent used to treat heart disease or disorders associated with blood clotting in the body, including heart attack, deep vein thrombosis and pulmonary embolism.


Warfarin INR
INR (Internation Normalised Ratio) is monitored to evaluate blood thickness in the body. High INR value indicates that blood is thin and has tendency of bleeding while Low INR value shows that therapeutic objective is not achieved where the blood is thick and has tendency to clot. INR value for a normal individual (before starting warfarin therapy) should be 1.0 and desired INR is different for different disease to be treated. Normally, INR value of 2-3 is indicated for most type of disease while value of 2.5-3.5 or higher is indicated for mechanical heart valves.


Sign of Bleeding
Warfarin has been known for its blood thinning activity that would predispose patient to bleeding tendency if not well controlled. For example, different patient has different warfarin sensitivity to warfarin therapy and before stable INR is achieved, patient may be more susceptible to warfarin side effects of bleeding. Hence, patient should be advised and educated regarding sign of bleeding and appropriate actions that should be taken. 
- Easy bruising / Skin discoloration or slow wound healing
- Hemotypsis / Cough or spitting of blood
- Gum bleeding
- Bloody urine or stool / black stool or dark urine
- Pale skin, light-headed feeling
- Sudden or severe leg pain / foot ulcer or purple toes or fingers
- Unsual bleeding either from nose, mouth, vagina or rectum
Depending on the severity of bleeding, patient should inform their doctor or pharmacist immediately.


Before undergoing any surgery including dental surgery like tooth extraction, patient should inform his practitioner so that warfarin therapy can be withold prior to the surgery.


Warfarin Diet
Patient should be educated to maintain consistent diet to optimize warfarin therapy. Vitamin K high containing food (reduce INR) should be reduced to minimize inteference with warfarin therapy. Examples of vitamin K high content food include leafy green vegetables, certain vegetable oils such as canola or soybean. 
Besides, patient should let their doctor or pharmacist know any supplement or medications taken including herbal products. Products such as coenzyme Q10, cranberry products, dong quai, garlic, Ginkgo biloba, ginseng, and St. John's wort would have affected warfarin therapy.
Furthermore, some medications like NSAID (ibuprofen, acetaminophen) and Aspirin would have increase INR value leading to higher risk of bleeding. Warfarin dose would be adjusted if patient is concurrently taking these medications. 
Also, certain antibiotics including azole group of antifungals (Fluconazole, Itraconazole), Metronidazole, Bactrim, Amiodarone would have lead to a significant increase in INR and should be taken into consideration before starting warfarin therapy.

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