In October, I rushed to the ER at Galveston’s John Sealy Hospital, run by UTMB (The University of Texas Medical Branch). I had edema, fluid retention that was pitting, and had been having difficulty with breathing for some time, but when chest pain hit, it was time to go to the ER. While there, they found massive multiple pulmonary embolisms-that is, many large blood clots that had traveled through my heart to the lungs, and had deposited themselves there, ready to cause infarctions (muscle death).
Coumadin Saves Lives
To treat these blood clots and save my life, I was started on a heparin IV and the doctors gave me Coumadin, a drug commonly called a “blood thinner”. Coumadin, or its generic form Warfarin, is not really a blood thinner, in that it doesn’t really ‘thin’ the blood. Rather, it works to slow clotting of blood, which sort of makes it seem like the blood is thinner, since patients will bleed more freely. The goal of Coumadin therapy is to prevent blood clots and/or break up blood clots quickly so they are small enough they do not do any damage to the heart or lungs.
Coumadin Alternatives
Coumadin is an inexpensive drug with a long history. Doctors are familiar with it, know its side effects, and prefer to work with Coumadin more than most other types of ‘blood thinning’ drugs. Unfortunately, Coumadin has some drawbacks that are hard to overcome. That’s why someone taking Coumadin must be careful to monitor diet, medications and supplements while on Coumadin, because so many things can interact with this medication.
However, the alternatives to Coumadin at this point are expensive, and many insurance plans do not cover these newer drugs. Also, many doctors are not well-versed in the use of these other drugs, and when a patient’s life is at risk, they prefer to use the medications with which they are familiar. If your doctor says you need blood thinners, do your research before simply agreeing to whichever drug prescribed.
Coumadin Therapeutic Level Testing
The hardest aspect of Coumadin therapy is getting the levels for a test called the PT/INR to the right therapeutic levels. This stands for Prothrombin Time / International Normalization Ratio . What it means is that the levels of the drug in the body are at the proper titration and the drug is working like it should: not too much so the patient is at risk of bleeding injuries but not so little that blood clots that are dangerous can continue to form. These medication levels, at least in the beginning, will be checked regularly.
My doctor has me testing my PT/INR weekly. For those who are lucky, the testing is now done by a finger poke. Unfortunately for me, and for anyone who gets a reading over 4.0 on the finger poke, the PT/INR has to be performed by a venous blood draw. For some reason, my levels never read right on the finger poke, so they always have to test my Coumadin levels from a vein in my arm, hand or wrist.
If the blood levels are too high, the doctor will likely tell the patient to hold the dose of Coumadin that evening, and then resume with a reduced Coumadin dosage for the next week and retest in a week. If the levels are too low, the doctor will likely increase the dosage for the week and retest in about a week. It’s a delicate balance to get the levels right and keep them stable.
The Coumadin Diet
It is extremely important for those taking Coumadin to keep the diet consistent in key nutrients. In particular, Vitamin K, which helps blood clot, can greatly impact levels and efficacy of Coumadin. Vitamin K is found in leafy green vegetables, certain oils and other foods. That’s not to say people shouldn’t eat these foods, but because it is so crucial that Coumadin levels remain steady and therapeutic, patients should eat similar amounts of Vitamin K containing foods every day.
The Coumadin Serving Exchange
That’s why I’ve started a Coumadin Exchange for my diet. I don’t want to have to force myself to eat a spinach salad every day, but I would like to have a spinach salad now and then. I also like broccoli, but who would want to eat that every day? So I made a chart of the foods I like to eat that contain Vitamin K and looked up on the internet to see how much they contained per serving and the size of the servings.
So now I know that I can have a half cup of fresh spinach for a spinach salad if I want, but if I’m not in the mood for spinach, I can replace it with two cups of steamed broccoli and still get about the same amount of Vitamin K. So that I’m able to have a wide range of food choices, we’ve set up three-Coumadin exchanges per day. This way, I can just glance at the chart quickly and know that any one thing I pick has the same amount of Vitamin K (or close to it) as another, and I can interchange or exchange anything on the chart with anything else on the chart.
Medication Interaction with Coumadin
Before taking any new medication or dietary supplements, and before taking any vitamins or minerals it is important to talk to a doctor. My doctor told me to never take a multi-vitamin while on Coumadin. St. John’s Wort, something commonly taken over the counter, can have bad interactions with Coumadin, as can ibuprofen and aspirin taken for pain. There are many other things on the shelves that can impact Coumadin levels, and when dealing with blood clots that can kill, it’s best to avoid anything that can harm the Coumadin action.
These are just some tips from a patient to other patients. I’m still relatively new to taking Coumadin, but I’ve been through the UTMB training on Coumadin and have listened closely to the anti-coagulation doctors and nurses who have helped me adjust to this medication. Any advice I’m giving here should be taken to your healthcare professional and discussed with him or her at length until you both are comfortable with the course of treatment for you and your Coumadin therapy. Don’t ever leave your health to chance: Always talk to your doctor before you change anything when you are a patient taking Coumadin.
SOURCES:
Vitamin K Chart: http://www.vaughns-1-pagers.com/food/vitamin-k-foods.htm
Prothrombin Time: http://www.webmd.com/a-to-z-guides/prothrombin-time
INR / International Normalization Ratio: http://www.medterms.com/script/main/art.asp?articlekey=9185