What is Warfarin Coagulopathy
Warfarin coagulopathy refers to bleeding that may occur as a complication of the medicine warfarin. Warfarin is a blood thinner (anticoagulant). Anticoagulants prevent dangerous blood clots. Bleeding is the most common and most serious complication of warfarin.
While taking warfarin, you will need to have blood tests (prothrombin tests, or PT tests) regularly to measure your blood clotting time. The PT test results will be reported as the International Normalized Ratio (INR). The INR tells your health care provider whether your dosage of warfarin needs to be changed. The longer it takes your blood to clot, the higher the INR. Your risk of warfarin coagulopathy increases as your INR increases.
What are the causes?
This condition may be caused by:
- Taking too much warfarin (overdose).
- Underlying medical conditions.
- Changes to your diet.
- Interactions with medicines, supplements, or alcohol.
What are the signs or symptoms?
Warfarin coagulopathy may cause bleeding from any tissue or organ. Symptoms may include:
- Bleeding from the gums.
- A nosebleed that is not easily stopped.
- Blood in stool. This may look like bright red, dark, or black, tarry stools.
- Blood in urine. This may look like pink, red, or brown urine.
- Unusual bruising or bruising easily.
- A cut that does not stop bleeding within 10 minutes.
- Coughing up blood.
- Vomiting blood.
- Feeling nauseous for longer than 1 day.
- Broken blood vessels in the eye (subconjunctival hemorrhage). This may look like a bright red or dark red patch on the white part of the eye.
- Abdominal or back pain with or without bruising.
- Sudden, severe headache.
- Sudden weakness or numbness of the face, arm, or leg, especially on one side of the body.
- Sudden confusion.
- Difficulty speaking (aphasia) or understanding speech.
- Sudden trouble seeing out of one or both eyes.
- Unexpected difficulty walking.
- Dizziness.
- Loss of balance or coordination.
- Unusual vaginal bleeding.
- Swelling or pain at an injection site.
- Skin scarring due to tissue death (necrosis) of fatty tissue. This may cause pain in the waist, thighs, or buttocks. This is more common among women.
How is this diagnosed?
This condition is diagnosed after your health care provider places you on warfarin and then finds out how it affects your blood’s ability to clot. Prothrombin time (PT) clotting tests are used to monitor your clotting factor. These tests also help your health care provider to find the warfarin dose that is best for you.
How is this treated?
This condition is treated with vitamin K. Vitamin K helps the blood to clot. You may receive vitamin K every 12 hours, or as needed. You may also receive donated plasma (transfusions of fresh frozen plasma). Plasma is the liquid part of blood, and contains substances that help the blood clot.
Follow these instructions at home:
Medicines
- Take warfarin exactly as told by your health care provider. This ensures that you avoid bleeding or clots that could result in serious injury, pain, or disability.
- Take your medicine at the same time every day. If you forget to take your dose of warfarin, take it as soon as you remember on that day. If you do not remember to take it on that day,do nottake an extra dose the next day.
- Contact your health care provider if you miss a dose or take an extra dose. Do not change your dosage on your own to make up for missed or extra doses.
- Talk with your health care provider or your pharmacist before starting or stopping any new medicines. Many prescription and over-the-counter medicines can interfere with warfarin. This includes over-the-counter vitamins, dietary supplements, herbal medicines, and pain medicines. Your warfarin dosage may need to be adjusted.
Eating and drinking
- It is important to maintain a normal, balanced diet while taking warfarin. Avoid major changes in your diet. If you are planning to change your diet, talk with your health care provider before making changes.
- Your health care provider may recommend that you work with a diet and nutrition specialist (dietitian).
- Vitamin K makes warfarin less effective. It is found in many foods. Eat a consistent amount of foods that contain vitamin K. For example, you may decide to eat 2 vitamin K-containing foods each day. Your warfarin dose is set according to the amount of vitamin K in your blood.
- Eat a consistent amount of foods that contain vitamin K. Vitamin K makes warfarin less effective, so eating the same amount each day enables your health care provider to set the correct dose of warfarin. You may decide to eat 2 vitamin K-containing foods each day.
Tests
- Make sure to have PT tests at least once every 4–6 weeks for the entire time you are taking warfarin.
Ask your health care provider what your target INR range is. Make sure you always know your target range. If your INR is not in your target range, your health care provider may adjust your dosage.
Preventing bleeding and injury
- Some
common over-the-counter medicines and supplements may increase the risk of
bleeding while taking warfarin. They include:
- Acetaminophen.
- Aspirin.
- NSAIDs, such as ibuprofen or naproxen.
- Vitamin E.
- Avoid
situations that cause bleeding. You may bleed more easily while taking
warfarin. To limit bleeding, take the following actions:
- Use a softer toothbrush.
- Floss with waxed floss, not unwaxed floss.
- Shave with an electric razor, not with a blade.
- Limit your use of sharp objects.
- Avoid potentially harmful activities, such as contact sports.
General instructions
- Wear or carry identification that says that you are taking warfarin.
- Make sure that all health care providers, including your dentist, know that you are taking warfarin.
- If you need surgery, tell your health care provider that you are taking warfarin. You may have to stop taking warfarin before your surgery.
- If you plan to breastfeed or become pregnant while taking warfarin, talk with your health care provider.
- Avoid
alcohol, tobacco, and drugs.
- If your health care provider approves, limit alcohol intake to no more than 1 drink a day for non-pregnant women and 2 drinks a day for men. One drink equals 12 oz. of beer, 5 oz. of wine, or 1½ oz. of hard liquor.
- If you change the amount of nicotine, tobacco, or alcohol you use, tell your health care provider.
- Keep all follow-up visits and lab visits as told by your health care provider. This is very important because warfarin is a medicine that needs to be closely monitored.
Contact a health care provider if:
- You miss a dose.
- You take an extra dose.
- You plan to have any kind of surgery or procedure.
- You are unable to take your medicine due to nausea, vomiting, or diarrhea.
- You have any major changes in your diet, or you plan to make major changes in your diet.
- You start or stop any over-the-counter medicine, prescription medicine, or dietary supplement.
- You become pregnant, plan to become pregnant, or think you may be pregnant.
- You have menstrual periods that are heavier than usual, or unusual vaginal bleeding.
- You have unusual bruising.
- You lose your appetite.
- You have a fever.
- You have diarrhea that lasts for more than 24 hours.
Get help right away if:
- You
develop symptoms of an allergic reaction, such as:
- Swelling of the lips, face, tongue, mouth, or throat.
- Rash.
- Itching.
- Itchy, red, swollen areas of skin (hives).
- Trouble breathing.
- Chest tightness.
- You
have any symptoms of stroke. BEFASTis an easy way to remember
the main warning signs of stroke:
- B – Balance. Signs are dizziness, sudden trouble walking, or loss of balance.
- E – Eye. Signs are trouble seeing or a sudden change in vision.
- F – Face. Signs are sudden weakness or numbness of the face, or the face or eyelid drooping on one side.
- A – Arm. Signs are weakness or numbness in an arm. This happens suddenly and usually on one side of the body.
- S – Speech. Signs are trouble speaking, slurred speech, or trouble understanding speech.
- T – Time. Time to call emergency services. Write down the time your symptoms started.
- You
have other signs of stroke, such as:
- A sudden, severe headache with no known cause.
- Nausea or vomiting.
- Seizure.
- You
have signs or symptoms of a blood clot, such as:
- Pain or swelling in your leg or arm.
- Skin that is red or warm to the touch on your arm or leg.
- Shortness of breath or difficulty breathing.
- Chest pain.
- Unexplained fever.
- You
have:
- A fall or have an accident, especially if you hit your head.
- Blood in your urine. Your urine may look reddish, pinkish, or tea-colored.
- Blood in your stool. Your stool may be black or bright red.
- Bleeding that does not stop after applying pressure to the area for 30 minutes.
- Severe pain in your joints or back.
- Purple or blue toes.
- Skin ulcers that do not go away.
- You vomit blood or cough up blood. The blood may be bright red, or it may look like coffee grounds.
These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.). Do not drive yourself to the hospital.
Summary
- Warfarin needs to be closely monitored with blood tests. It is very important to keep all lab visits and follow-up visits with your health care provider. Make sure you know your target INR range and your warfarin dosage.
- Monitor how much vitamin K you eat every day. Try to eat the same amount every day.
- Wear or carry identification that says that you are taking warfarin.
- Take warfarin at the same time every day. Call your health care provider if you miss a dose or if you take an extra dose. Do notchange the dosage of warfarin on your own.
- Know the signs and symptoms of blood clots, bleeding, and stroke. Know when to get emergency medical help.
