Warfarin

• Possible side effects of Warfarin include:
• Unexplained nose bleed
• Bleeding from gums when brushing teeth
• Prolonged bleeding from minor cuts (10-15 minutes) despite applying pressure on wound. Action: Check with your doctor if the bleeding does not stop within 15 min or if you feel unwell
• Excessive menstrual bleeding (women) Action: For women, increased menstrual flow is common but check with your doctror if you feel unwell.
Serious side effects of warfarin overdose include:
• Blood in urine or cloudy and dark urine
• Black, sticky or tarry stool (not due to iron supplement)
• Coughing up blood or coffee ground-like vomit
• Unexplained large bruises or purplish area on skin
• Sudden severe headache with nausea or loss of consciousness Action: Check with your doctor immediately or admit yourself to the Accident and Emergency Department (A&E) if you experience any of the symptoms or feel unwell

• Effect of warfarin depends on the amount of Vitamin K in your body which is mostly derived from your diet
• Eat a well-balanced diet while you are on warfarin
• Ensure consistent and moderate consumption of Vitamin K rich food (Refer to the table at the bottom of this page)
  
• Avoid making any MAJOR CHANGES to your diet (e.g. becoming a vegetarian) without first consulting your doctor or pharmacist
• Avoid excessive alcohol consumption. It is advisable not to take more than 5 cans of beer or 1 bottle of wine per week
• Avoid any form of traditional or herbal remedies and over-the-counter supplements (e.g. gingko, garlic, cordyceps and ginseng) as their effect on warfarin is unpredictable
• Consult your doctor or pharmacist before you start or stop taking any medication or supplements. Certain medications like pain killers, antibiotics, and hormonal

• Warfarin can be taken with or without food
• Take at the same time, once daily
• DO NOT miss, double or adjust your dose unless directed by your doctor or pharmacist

What happens when you start Warfarin

• You will be given a booklet called Anticoagulation Therapy Record that provides an ongoing record of your blood tests and warfarin dosage
• Remember to bring the booklet with you every time you visit Anticogulation Clinic
  
• Warfarin dose is adjusted according to your desired International Normalised Ration (INR) that measures the effectiveness of warfarin and its bleeding risk
• Your desired INR range is: _____________________
• Blood tests may be required more frequently to determine the appropriate warfarin dose
• Your dose may change after each visit depending on your INR result. Your doctor or pharmacist will inform you any dose changes
• Inform your doctor or pharmacist of any illnesses, hospitalisation, changes in medication(s) or lifestyle at your next appointment
• Inform other healthcare professionals (doctors, dentist, pharmacist) whom you are seeing for other condition(s) that you are on warfarin
  

• Take it as soon as you remember if it is within 8 hours of your usual time to take warfarin
• If it is after 8 hours, skip the dose for that day
• Just take your warfarin dose at the usual time the next day
• DO NOT take double doses, unless your doctor tells you to, as this can cause excessive bleeding
• Record the dates on which you missed your dose(s). Inform your doctor at your next appointment

• Keep away from children
• Keep in a cool, dry place, away from direct sunlight
• Store at room temperature

What else do you need to know about warfarin?

• Inform your doctor if you have not been eating well or feeling unwell (e.g. fever, vomiting, diarrhoea, infection)
• Avoid intramuscular injection because it may lead to haematoma (bleeding in the muscle)
• Ensure that you keep sufficient warfarin supply at all times especially if you need to travel
• If you are pregnant or intending to get pregnant, please inform your doctor as warfarin may affect your foetus

Do you need to make any lifestyle changes?

• No need to make any changes to your lifestyle. Keep it consistent and have a well-balanced diet.
• Be extra cautious when handling razors or other sharp objects
• Avoid contact sports or other activities that may cause you to be injured and lead to excessive bleeding