On warfarin? Anticoagulant clinics can help

Patients on warfarin need periodic blood tests to make sure the medication is working properly. This complicated process is often completed with the help of an anticoagulant clinic.

graphic of woman in anticoagulant clinic with microscope looking at heart

Anticoagulants can save lives of people who have heart defects and clotting disorders or related health problems.

Your health care provider may advise you to take warfarin when you have a health condition that increases your risk of forming abnormal blood clots in your blood vessels.

Common conditions that increase the risk of abnormal blood clotting include:

A blood clot forms to stop wounds from bleeding. A blood clot can also block vessels and stop blood from flowing to organs. This can cause:

A stroke when blood flow is stopped to the brain
A heart attack when blood flow is stopped to the heart
A pulmonary embolism when blood flow is stopped to the lungs

For blood to clot (or scab), a series of chemical reactions occur in your blood. Vitamin K is necessary for those chemical reactions to cause blood to clot. Warfarin blocks the effect of vitamin K on these reactions, slowing down your body’s ability to form a blood clot.

“Warfarin has been in use for many years, however there are new anticoagulant medicines on the market that require less monitoring,” said Melissa Mikelson, Director of Care Management for Marshfield Clinic Health System. “Talk to your provider to determine which anticoagulant is right for you.”

What anticoagulant clinics do

The blood test to monitor clotting time is called the international normalized ratio (INR). Patients on warfarin need to have their INR drawn routinely. The frequency you need to complete an INR draw can change if you are outside of your target range.

Marshfield Clinic Health System has an anticoagulant clinic called Anticoagulation Services that is staffed by registered nurses. These specially trained nurses work by phone or My Marshfield Clinic (the patient portal) with patients on warfarin. The nurses monitor nearly 4,100 patients who are prescribed warfarin.

“This service has been available since 1999. Nurses call or message patients regularly supporting a safe and effective patient follow up,” Mikelson said. “Our service is pleased to help facilitate the option of INR home testing. Approximately 700 patients utilize a home monitor machine.”

Nurses manage patients’ warfarin dosage, order follow up labs, coordinate care throughout the health system and provide education.

Keeping your INR in range

Diet changes, physical activity, illness and other medications can impact your INR result. Talk to your anticoagulation clinic if any of these things have changed.

Here are some tips to help manage your INR:

Eat a well-balanced diet with a steady and consistent amount of vitamin K
Eat vitamin K foods in moderation and try to be consistent
Food labels list vitamin K content. If it is not listed on the label, it is considered to be low in vitamin K. If the food label states vitamin K is 20 percent or greater, it is in the medium to high range.
Limit beer, wine or hard liquor to no more than 1-2 drinks a day.

The recommended daily intake for Vitamin K is 90 micrograms for females over the age of 18 and 120 micrograms for males over the age of 18.

Increased bleeding and bruising a risk for warfarin

Since warfarin slows your body’s ability for form a blood clot, you may notice that you bleed or bruise more after an injury.

“Warfarin can increase risk of serious bleeding problems from an injury, even when the dose may be at the recommended level,” Mikelson said. “Even the smallest cut can seem to bleed forever or you may notice more bruises.”

It is important to take precautions to avoid injury that could lead to bleeding or bruising. Making a few adjustments can prevent most home accidents and injury.