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heparin warfarin cautions used in CCSVI therapy

Posted: Wed May 27, 2009 6:49 am
by peekaboo
source Webmd

Taking Heparin and Warfarin for Deep Vein Thrombosis (DVT)
Heparin and warfarin (Coumadin) are two types of blood thinners (anticoagulants) commonly used in deep vein thrombosis treatment. Though they're called blood thinners, these DVT treatments do not actually thin your blood. If you have DVT treatment, it can keep existing blood clots from getting larger or prevent new ones from forming. They do this by preventing the production of certain proteins needed for blood to clot.

Heparin and Warfarin: The Basics
If you're taking heparin and warfarin for DVT, be sure you:


Tell your doctor about all other medications you take -- including over-the-counter drugs, herbal remedies, and vitamins or other supplements. Some medications can weaken or strengthen the effects of heparin and warfarin, which can be extremely dangerous.
Do not take aspirin with blood thinners unless your doctor says it's OK.
Tell all your doctors and dentists that you're taking heparin and warfarin.
Tell your doctor if you're trying to become pregnant or have become pregnant as warfarin can cause birth defects.
Tell your doctor if you have an accident of any kind. Anticoagulants increase your risk of bleeding.
Let your close family members know how you take your blood thinners.
Carry an emergency medical ID card that contains the name of the medication you're taking; your name, phone number, and address; and the name, phone number, and address of your doctor.
Tips for Taking Heparin and Warfarin for DVT
If you're taking heparin or warfarin for DVT, you should know the following:

Heparin: Traditionally, people have received heparin intravenously (by IV into a vein) in the hospital for about five to seven days. However, low-molecular-weight heparin is effective within hours, reducing complications and hospitalizations. You can give yourself the injections at home, once or twice daily, on an outpatient basis. And because low-molecular-weight heparin is more consistent and predictable, it doesn't require regular blood tests.

Warfarin: You take warfarin by pill once a day, beginning while you're still on heparin. Treatment may continue for about three to six months. While on warfarin, you need regular blood tests to ensure you have the correct dosage.

Ask your doctor how long you will need to take heparin and warfarin. And follow these six tips for taking these anticoagulants:

Take heparin and warfarin exactly as your doctor tells you to.
Take your medication at the same time each day. Your doctor may recommend taking it in the evening so it's easier to make any adjustments in your dosage.
Always double-check your pills when you get a new prescription. Tablets are color-coded. They also have the milligram strength printed on them. If the dose differs from your last one, check with your doctor or pharmacist to make sure it is correct.
Do NOT follow label directions for warfarin. Your dosage is adjusted depending upon your blood results.
Call for refills of your heparin and warfarin prescriptions before you run out. It is risky to go even one day without your medication.
If you do miss a dose, call your doctor or clinic for instructions. Don't try to make up for missed doses or change your dose on your own for any reason.
Monitoring Your Blood While on Warfarin for DVT
Taking warfarin for DVT is a balancing act. Warfarin decreases blood clotting. You want to receive enough warfarin to decrease your risk for blood clots, but not so much that clotting stops completely. If this happens, you're at high risk for bleeding problems. This is why the doctor needs to monitor your blood while you're on this medication.

The test used most often to monitor the effect of warfarin is called prothrombin time (PT). The results of this test determine how high or low your dose of warfarin should be. Your dose may be higher when you first begin treatment, then it may be adjusted to a maintenance level. The doctor may also adjust your warfarin dose in response to your circumstances, such as being scheduled for surgery or needing to take other medications.

Let your doctor know if you're planning to travel. You may need to make arrangements for blood tests right before you leave and while you're away.

Taking Precautions While on Heparin and Warfarin
To prevent bleeding problems, take these precautions while you're on heparin and warfarin:

Don't smoke.
Use a soft toothbrush.
Floss with waxed floss, instead of unwaxed floss.
Instead of a straight or blade razor, use an electric razor.
Wear gloves while gardening or doing other household projects.
Avoid rough sports, but wear protective gear for activities such as bicycling.

Foods that are rich in vitamin K can make warfarin less effective. Try to avoid large amounts of these foods, but do not suddenly lower your intake without discussing this with your doctor.

Beef or pork liver
Green tea
Alfalfa
Asparagus
Broccoli
Brussels sprouts
Cabbage
Cauliflower
Lettuce, spinach, kale, or turnip greens
Watercress
Canola and soybean oil
Also, talk with your doctor before taking vitamin E or changing your dose. Vitamin E may increase the impact of warfarin. Avoid alcohol or drink only limited amounts. It can also impact how your body handles warfarin.

Potential Side Effects of Heparin and Warfarin
If you're taking heparin or warfarin for DVT, call your doctor right away if you have any of the following signs or symptoms. Many are signs of excessive bleeding.

Red or dark brown urine
Red, dark brown, or black stool
Periods that are heavier than usual
Bleeding gums
Nosebleeds
Cuts that don't stop bleeding
Severe headache or stomach pain or upset
Weakness, faintness, or dizziness
Frequent bruises or blood blisters
Skin rash or irritation
Unusual fever
Joint or back pain
Swelling or pain at an injection site

Posted: Wed May 27, 2009 7:31 am
by mrhodes40
This is a big drug and it has important implications once on it. Thanks for posting this Peek!

Posted: Wed May 27, 2009 11:52 am
by Sharon
Peek - good information - thanks

Posted: Wed May 27, 2009 12:30 pm
by jimmylegs
vitamin E seems to be a somewhat nicer anticoagulant, but not to be taken with warfarin since it "interferes with" its action. (i take this to mean, given the abstracts i have read on the subject, that they both do the same thing)
with blood thinners there can certainly be too much of a good thing.
i sent some related abstracts to skydog and could post them here if anyone wants to check them out.

Posted: Mon Jun 01, 2009 10:38 am
by Arcee
I met with my PCP today to review everything well ahead of my trip to stanford next month. She is really excited and supportive! She also made a suggestion that I want to pass on. She said if I do end up on warfarin, I should go to an anti-coagulant clinic for the testing and medication adjustments. Apparently they will do a pin prick and be able to immediately adjust the medication rather than going somewhere for a blood draw, waiting for the PCP's analysis, etc. I am not sure how common these clinics are, but it sounds like a great idea if you live near one.

Re: heparin warfarin cautions used in CCSVI therapy

Posted: Mon Jun 01, 2009 3:21 pm
by NHE
Arcee wrote:She also made a suggestion that I want to pass on. She said if I do end up on warfarin, I should go to an anti-coagulant clinic for the testing and medication adjustments. Apparently they will do a pin prick and be able to immediately adjust the medication rather than going somewhere for a blood draw, waiting for the PCP's analysis, etc. I am not sure how common these clinics are, but it sounds like a great idea if you live near one.
I have an older family member age 74 who is on warfarin due to some heart problems. They regularly go to a warfarin clinic to get their blood clotting ability tested and their warfarin dosage adjusted if necessary. So far, it has worked out fairly well.

NHE

Posted: Mon Jun 01, 2009 3:31 pm
by cheerleader
The warfarin (called coumadin when taken orally) only needs to be taken for two months in Dr. Dake's protocol. At that time, the stents will be checked by MRV to make sure they are patent (incorporated by the vein as part of it, with a lining of endothelial cells)

Jeff's at week four tomorrow, so he'll go back in a month to Stanford for his check up. If all is well, he discontinues taking the coumadin. He will continue taking plavix for the rest of his life....to avoid clotting. He's stayed on the Swank diet, but discontinued his supplements while on the coumadin. He went for a bike ride yesterday, felt good to get back on his bike, but he stayed on the street...didn't want to risk a fall on the trails while on coumadin. This is definitely something to consider if contemplating a stent procedure.
cheer

Posted: Mon Jun 01, 2009 6:32 pm
by mrhodes40
We've had trouble getting my INR to be correct so I have had more frequent checking so far 2 times a week, but once we get the level we want --INR 2.5-- that'll drop off for me. my INR is now 1.9.

I still have bruising from my femoral access 2 weeks ago, bu twe checked to day and there is no ongoing bleeding in the abdomen so I am good to go there. I should get to use the finger prick after this week too it seounds good to me

You do need to be aware of unusual bleeding type things which is why the ongoing bruising needed to be investigated.
marie