Coumadin is frequently prescribed for thrombosis disorders such as: deep venous thrombosis (DVT) and pulmonary embolism (PE), as well as cardiovascular disorders such as atrial fibrillation (AF), heart valve replacement, peripheral vascular disease and cerebrovascular disease (stroke). This medication has the ability to prevent blood clots, which can be damaging to these various bodily organ systems. However, Coumadin has a very narrow therapeutic index. At too low a dose there is no benefit from taking the medication, and too high a dose there is a distinct risk of bleeding complications and possibly death.

Your cooperation and knowledge about this medication makes its use much safer and more effective. In the practice of Florida Heart Associates, Coumadin monitoring requires close attention to detail and cooperation with patients in the following items.

1. You must know the reason why you are taking Coumadin. You may state this in common, ordinary, every day language, or you may memorize the medical term for why you are taking this medication, and for how long you are to take Coumadin.

2. You must know, without error, how much Coumadin you are taking. You must know how many tablets you are taking each day, what the strength of the tablets are, and the total number of milligrams per day that you are taking of Coumadin.

3. You must come to the office Coumadin clinic for a Protime/INR measurement (blood test) to measure the effect of Coumadin on your blood as ordered by your physician.

4. At your meeting with the physician or nurse, is and opportune time for You to ask any questions about Coumadin therapy, plan it's management around any other surgical or medical procedures that you are to receive, discuss potential interactions with your other medications. Any other changes in your health could effect the safety Coumadin and it's use should also be discussed at this time.

5. Patients should understand the term INR and what their INR should be. INR stands for International Ratio. This is a standardized ratio used worldwide to prescribe Coumadin, so if you travel no matter where you go this ratio will be used to adjust your Coumadin.

   1. Deep venous thrombosis (DVT) Pulmonary embolism (PE) Atrial Fibrillation (AF) Cerebrovascular disease (stroke) Peripheral vascular disease INR 2-3

   2. Valvular heart replacement INR 2.5-3.5

INSTRUCTIONS

1. Doses are to be at the same time every day. No alternative dosing schedule. Coumadin should be taken at dinner time ( 6pm).

2. Report all medication changes.

3. Stop Coumadin before surgery as per your physicians recommendations. Do not stop for dental cleaning or fillings, only for extractions.

REPORT ANY OF THE FOLLOWING TO YOU PHYSICIAN OR NURSE

1. Fever or illness, including vomiting, diarrhea, or infection

2. Pain, swelling, discomfort, or any other unusual symptoms

3. Prolonged bleeding from cuts or nosebleeds

4. Unusual bleeding from gums when brushing your teeth

5. Increased menstrual flow or vaginal bleeding

6. Red or Dark brown urine

7. Red or black stools

8. Unusual brusing for unknown reasons

9. Patient becomes pregnant, plans to become pregnant or intends to breast feed

10. Chest pain or shortness of breath

HELPFUL SUGGESTIONS

1. Do not start, discontinue, or change other prescription or nonprescriptive medication without health care providers advice.

2. Always tell other doctors, dentists, pharmacists, or nurses that you are taking Coumadin.

3. Maintain your same general diet from day to day. Eating increased amounts of green leafy vegetables may affect your INR and cause you to have to keep changing your dose. You may eat salads butt remember to keep your diet consistent. If you like to eat them a couple days a week just continue to do so.

4. Do not drink Alcohol.

5. If you miss a dose take the missed dose as soon as possible on the Same day, but NEVER take double the dose of Coumadin the next day.

The most common side effect and serious risk of oral anticoagulation therapy with Coumadin is bleeding in any tissue or organ.

VITAMIN K

Coumadin blocks the formation of vitamin K-dependent clotting factors in you liver. Vitamin K is needed to help make your blood clot and prevent bleeding.

The amount of vitamin K in your diet may effect your protime. Eat a normal, balanced diet maintaining a consistent amount of vitamin K. DO NOT make drastic changes in your dietary habits.

In general, leafy, green vegetables, certain legumes and vegetable oils contain high amounts of vitamin K.

Use the following list of foods to help you keep the right amount of vitamin K in your diet.

HERBAL PRODUCT USE

Caution should be taken when Herbal products are taken together with Coumadin. The use of Herbal products may increase or decrease the effects of your Coumadin depending on the produce you are taking.

Some Herbal products that INCREASE the effects of coumadin:

Some Herbal products that DECREASE the effects of Coumadin:

(the brew of green tea are not a significant source of vitamin K)