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Coumadin Do's and Don'ts

Jean Donovan, a nurse practitioner in the  Arrhythmia Service at the  CardioVascular Institute at Beth Israel Deaconess Medical Center, answers questions about successful Warfarin therapy for  atrial fibrillation patients.

Q. CoumadinĀ® (brand name) or warfarin (generic name) has saved thousands, perhaps even millions of lives, yet atrial fibrillation patients often have ambivalent feelings about it. Why is that?

A. Warfarin is a very effective medication, however, it requires very close monitoring, including frequent blood draws to ensure that the blood levels are in the correct range, which many patients find inconvenient. They also need to be aware of potential interactions with other medications and food.

Q. What is the reason afib patients are so often put on warfarin?

A. There is an increased risk of stroke associated with atrial fibrillation. Warfarin is the most effective blood thinner currently commercially available to prevent stroke.

Q. What are the side effects of warfarin?

A. Bruising is the most common. If levels are higher than the recommended range, bleeding may occur.

Q. Do you have any tips for taking warfarin successfully ("do's")?

A. (1) Take your warfarin at the same time every day. (2) Maintain a consistent diet with regard to green, leafy vegetables. (3) Have your blood monitored per recommendations of your provider. (4) Inform all other providers (such as your dentist) that you are on warfarin. (5) If you are prescribed antibiotics, it is important to make sure that the provider managing your warfarin is aware. You will likely need more frequent blood monitoring during that period of time.

Q. Is there anything you shouldn't do when on warfarin ("don'ts")

A. (1) Do not stop warfarin unless directed by your health care provider. (2) Avoid non-steroidal anti-inflammatory drugs (such as ibuprofen, Motrin, Advil) unless you take them under the direction of your health care provider. (3) You should avoid participating in high impact activities such as skiing or contact sports unless discussed with your provider.

Q. Are there any other drugs that provide the benefits of warfarin without the side effects, including aspirin?

A. For some patients with atrial fibrillation, an aspirin alone is considered sufficient for anticoagulation. In general, these are patients that are younger than 70, with no other risk factors for stroke.

Q. Are researchers and pharmaceutical companies working on an alternative to warfarin?

A. Yes, there is a new medication that may be as effective as warfarin and could be available as early as 2011.

Q. Are atrial fibrillation patients ever able to stop taking warfarin?

A. Yes, there are some patients who will be on warfarin for a short period of time. The decision to stop warfarin is made on an individual basis and takes into account the patient's other risk factors for stroke.

Q. What about patients who have blood clotting issues - can they take warfarin?

A. The decision to start a patient on warfarin is based on many factors, including all the patient's other medical conditions. The risks/benefits of starting warfarin would be discussed with the patient and the health care provider.

Contact Information

Cardiovascular Medicine
Division of the CardioVascular Institute
Beth Israel Deaconess Medical Center
330 Brookline Avenue
Boston, MA 02215
617-667-8800

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