If you have ever had atrial fibrillation (a common heart arrhythmia), a deep vein thrombosis (DVT), a TIA or stroke, a pulmonary embolism, heart valve disease or have had a heart valve replacement, you are probably taking some form of anti-coagulation therapy.  Coumadin/Warfarin is the most common drug used.

You have also been warned about the side effects of this medication, such as excessive bleeding which can be manifested in black stool, orange or red urine, swelling of a joint due to bleeding or large bruises.  You have been reminded to watch your diet and to report for blood work on a regular basis. At some time or another, you have also probably ignored these warnings and practices. 

It is amazing to those of us in medical practice how often otherwise intelligent people do not take the teaching about anti-coagulant therapy seriously.  We commonly have to treat people with serious blood loss as a consequence of Coumadin/Warfarin therapy because they have ignored the pleas of their physicians to have regular lab work done.  The purpose of this article is to give a simple formula to follow when on anticoagulation therapy by remembering the word – BEST.

 B - Be careful
 E - Eat right
 S - Stick to a Routine
 T - Test Regularly

Be careful.  If you fall, particularly if you have a hard fall, call your doctor immediately.  A very good friend of mine on Coumadin therapy almost lost his life when he had a biking accident yet wasn’t concerned about the bruise on his abdomen.   He almost bled to death and spent several days in intensive care. Take every injury seriously.  Just because you can’t see blood does not mean you are not bleeding.

Eat right.  Certain vegetables effect clotting time because they contain large amounts of Vitamin K, a natural anti-coagulant.  These foods are Asparagus, Avocado, Broccoli, Brussels sprouts, Cabbage, Canola oil, Cranberries, Endive, Green onions, Kale, Lettuce, Liver, Margarine, Mayonnaise, Parsley, Soybean oil, Soybeans, Spinach, Turnip, collard and mustard greens.

Stick to a routine.  Exercise is good for you but avoid contact sports. Wear heavy gloves and shoes when working outdoors.  Be careful when working with sharp objects and make sure that you wear protective helmets and clothing when riding a bike or motorcycle.

Test regularly.  This is the most important element to remember when on anti-coagulation therapy.  Coumadin/Warfarin is prescribed according to the blood tests, Protime and INR. Both test the ability of the blood to clot.  The normal Protime is 10-13 while the normal INR is between 1.0-1.4.  When a patient is on Coumadin/Warfarin therapy, physicians like the PT (Protime) to be 1.5 to 2 times the normal PT and the INR to be between 2 and 3.  When the INR exceeds 3.5, the patient is in danger of bleeding. The higher the INR the greater the danger becomes.  In some patients the INR can rise rapidly, putting the patient in danger of hemorrhaging.  Those patients require more frequent testing and may have to return for blood draws once a week instead of once a month.

Certain medications such as all of the over the counter pain medications, especially aspirin, Alka Seltzer, Ex-lax, Midol, Pamprin, Pepto Bismol, Sine-Off, Tagamet, Centrum, Garlic, Ginkgo biloba and green tea can effect PT and INR levels. Be meticulous about giving your physician a list of all prescribed medications, over the counter medications and the herbal supplements that you take.

Also keep in mind that diarrhea, vomiting and nausea can affect the absorption of Coumdin/Warfarin so notify your doctor if you are suffering from these symptoms.

If you are on anticoagulation therapy remember BEST in order to stay your best.