If you have suffered a deep vein thrombosis of the lower or upper extremities, most likely the doctor will prescribe you an indirect anticoagulant. The main drug of this group today, both here and abroad, is Coumadin. The above recommendations are mostly applicable to any anticoagulant. The purpose of this drug is to prevent the re-formation of blood clots, fraught with a sharp deterioration in your condition or the development of life-threatening complications. The risk of recurrence of thrombosis is quite large during the first year after the first episode of the disease, therefore, taking into account various factors, Coumadin tablets are appointed for a period of 2 to 12 months. In rare cases, longer therapy is provided. Indirect anticoagulants do not have an effect on the already formed thrombus.
To determine the duration of Coumadin treatment, sometimes special (including genetic) blood tests are required to identify an increased tendency to thrombosis. A very large number of patients all over the world receive this treatment. It is used not only in phlebology, but also in such a field of medicine as vascular surgery. In addition to deep vein thrombosis, the basis for prescribing anticoagulant therapy is often advanced heart attacks, heart rhythm disorders, valve and peripheral vascular prosthetics, and much more.
A drug reducing the ability of blood to fold, so its excess can lead to hemorrhagic complications, i.e., bleeding. To avoid complications, the necessary Coumandin dosage is monitored by a blood test, which is called the INR (International Normalized Ratio). Sometimes it can be labeled INR in laboratory responses. During the entire period of taking medication, INR should be in the range 2.0 - 3.0. If INR is less than 2.0, then clotting is not reduced and thrombotic complications are possible. If INR is greater than 4.0 - hemorrhagic complications are very real. Increasing INR from 2.5 to 4.0 indicates the need to reduce the dose of the drug, but, usually, does not carry an immediate threat. For some diseases, the required upper bound of INR is 4.0 - 4.4.
In the absence of the possibility of determining INR, we can control prothrombin time (PT), but this method is significantly less reliable. To calculate the dose other blood tests are not needed. To determine the side effect of the drug, a general blood test, urine and some biochemical tests are periodically prescribed. It is taken with the whole daily dose at one time, preferably at 17 - 19 hours. It is not recommended to take it with food; it can be taken on an empty stomach. Dose selection can be carried out both against the background of the use of low molecular weight heparins and without them, both inpatient and outpatient. The selection period takes on average 1 to 2 weeks, but in some cases it increases to 2 months. At this time you will need a frequent definition of INR, up to 2 - 3 times a week or daily. Each time, after receiving the next result of the study, your doctor will determine the change in the dose of the medicine and the date of the next analysis. If in several analyzes the INR remains in the range 2.0 - 2.5, this means that the dose is selected. Further monitoring of treatment will be much easier. If the dose of the drug is chosen, a more rare control is sufficient - first once every 2 weeks, then once a month. The frequency of additional studies is determined separately. The need for an extraordinary definition of INR may arise in a number of cases, which we will discuss below. If in any doubt, consult your doctor for advice. Currently, there are portable devices for self-determination of INR (by the type of systems for monitoring blood sugar in diabetic patients), however their cost is very high and, in most cases, deep vein thrombosis, their acquisition is inappropriate.
Coumadin acts on the coagulation of blood through vitamin K, which in varying amounts is contained in food. Do not avoid foods high in vitamin K! The food should be high-grade. It should only be monitored that there is not a significant change in their share in the diet, for example, depending on the season. If you significantly increase the intake of foods rich in vitamin K against a selected stable dose this can greatly weaken its effect and lead to thromboembolic complications.
Coumadin side effects do not develop so often. Most of them are associated with increased bleeding. To reduce the risk of bleeding, your INR values should remain within your defined limits. Small bleeding may occur even if your INR level does not exceed the recommended values. For example, you may notice small bruises or increased bleeding gums. Some people notice dry skin or problems with hair, but this happens very rarely and goes away with time. If you feel anything that, in your opinion, may be related to taking Warfarin, please inform your doctor.
Light bleeding - can appear from time to time:
- Gum bleeding in the morning toilet.
- Causes of nasal bleeding.
- The causeless appearance of small bruises.
- Bleeding after a minor injury, which does not stop for several minutes.
- Menstrual bleeding, which is slightly more plentiful than usual.
