Documente Academic
Documente Profesional
Documente Cultură
Is there any harm in taking long-term, low-dose warfarin for an extended period after an episode of deep vein thrombosis?
Answer
from Martha Grogan, M.D.
Warfarin (Coumadin) is a blood-thinning medication (anticoagulant) used to treat and prevent blood clots. For most people with a single episode of deep vein thrombosis (DVT), treatment with full-dose blood thinners is usually for only a limited time. Taking warfarin at a high dose for a longer period of time is only recommended for people who are at a high risk of developing blood clots that could cause a heart attack, stroke or pulmonary embolism.
Long-term, low-dose treatment with warfarin may prevent future episodes of DVT, but it's not without risk. There's a risk of serious or even fatal bleeding especially when warfarin is taken in high doses or for long periods of time.
Ask your doctor to help you weigh the benefits and risks of long-term, low-dose warfarin therapy in your case. Also consider these self-care measures to prevent future episodes of DVT:
Avoid sitting, squatting or crossing your legs for long periods of time. If you must sit for long periods, such as during a plane or car trip, take a short walk every hour or two. It also helps to flex your ankles, curl your toes and tap your feet frequently.
Drink plenty of fluids to prevent dehydration. Wear support hosiery or compression stockings, available at medical supply stores. If you're taking warfarin to prevent blood clots that could cause a heart attack or stroke, make sure you take it exactly as prescribed. Warfarin is a powerful medication that can have dangerous side effects.
If your doctor prescribes warfarin for you, make sure you understand all the potential warfarin side effects and interactions it could have.
A blood clot in or near your heart that could trigger stroke, heart attack or organ damage A blood clot in your lungs (pulmonary embolism) A blood clot elsewhere in your body (venous thrombosis) A high risk of blood clots forming in the heart, such as in some heart rhythm abnormalities (arrhythmias) A mechanical artificial heart valve that is prone to forming blood clots
Severe bleeding Black stool or bleeding from the rectum Skin conditions such as hives, a rash or itching Swelling of the face, throat, mouth, legs, feet or hands Bruising that comes about without an injury you remember Chest pain or pressure Nausea or vomiting Fever or flu-like symptoms Joint or muscle aches
Diarrhea Difficulty moving Numbness or tingling in any part of your body Painful erection lasting four hours or longer Although rare, warfarin can also cause skin tissue death (necrosis) and gangrene requiring amputation. This complication most often happens three to eight days after you start taking warfarin. If you notice any sores, changes in skin color or temperature, or severe pain on your skin, notify your doctor immediately.
Gas Feeling cold Fatigue Pale skin Changes in the way foods taste Hair loss
Tell your doctor about any other medications or supplements you take. Many medications and supplements can have a dangerous interaction with warfarin.
Tell your health care provider you take warfarin before you have any medical or dental procedures. Tell providers that you take warfarin even before minor procedures, such as vaccinations and routine dental cleanings. If you're going to have surgery, discuss what dosing changes might be necessary at least 10 days before the procedure. Your doctor may decrease your dose of warfarin or discontinue warfarin altogether before the procedure. Talk to the doctor who prescribed warfarin to find out if it's safe to discontinue for a few days. If you are at high risk of blood clots, you may need a shorter acting blood thinner, heparin, to keep a lower risk of blood clots while you're not taking warfarin.
Avoid situations that increase your risk of injury. Avoid contact sports or activities that could result in head injury. Make sure you tell your doctor if you are unsteady while walking or have a history of falling.
Consider wearing a bracelet or carrying a card that identifies that you take warfarin. This can be useful if emergency medical personnel need to know what medications you take.
Consider a warfarin sensitivity test. About a third of the people who take warfarin are at a higher risk of bleeding because their genes make them more sensitive to warfarin. If you're worried that you might be more sensitive to warfarin because a family member experienced side effects, talk to
your doctor about taking a genetic warfarin sensitivity test. The test can tell if you have the genes that can increase your risk of bleeding, although researchers are still looking into whether genetic tests are more effective than carefully monitoring your body's response to warfarin.
If you receive new prescriptions from someone other than your usual medical provider, make sure to remind him or her that you're taking warfarin. Ask if you'll need additional blood tests from your regular care provider to make sure your blood clotting hasn't been affected by the new medications you're taking. Next (1 of 2) page
Mayo Clinic products and services Warfarin side effects: Watch for interactions What drugs and supplements can interact with warfarin?
Warfarin, like any other medication, can interact with foods, other drugs, vitamins or herbal supplements. Be ready to provide your doctor with a complete list of everything you're taking.
Aspirin or aspirin-containing products Ibuprofen (Advil, Motrin, others) or naproxen (Aleve, Anaprox) Acetaminophen (Tylenol, others) or acetaminophen-containing products, especially when the dose of acetaminophen exceeds 1,500 milligrams a day Many antibiotics Heparin Cold or allergy medicines Birth control pills Medications that treat abnormal heart rhythms, such as amiodarone This isn't a complete list. Many other medications interact with warfarin. You should always consider that a new medication could interact with warfarin until your doctor, nurse or pharmacist tells you otherwise.
Fish oil and omega-3 supplements Vitamin K Alfalfa Bromelains, a type of supplement that comes from pineapples (pineapple itself doesn't interact with warfarin) Coenzyme Q10 (ubidecarenone)
Cranberry extracts Danshen Dong quai Evening primrose oil Garlic Ginkgo biloba Ginseng Glucosamine St. John's wort Willow bark Wintergreen
Garlic and black licorice also may interact with warfarin, so talk to your doctor if you eat a lot of these foods.
Eating cranberries or drinking cranberry juice can affect the way warfarin works and can increase your risk of bleeding. While an occasional glass of cranberry juice is unlikely to injure you, you should avoid drinking it regularly.
Drinking alcohol also can affect the way warfarin works. Talk to your doctor about drinking alcohol while taking warfarin. While having an occasional drink shouldn't create a problem, excessive drinking or binge drinking can greatly increase your bleeding risk.
Always talk to your doctor if you're unsure if you took your warfarin as directed. If you follow your doctor's dosing instructions and tell all your health care providers that you take warfarin, you'll be at a much lower risk of dangerous interactions and warfarin side effects. Talk to your doctor, nurse or pharmacist if you have any concerns about warfarin. They can be a valuable source of information. Previous (2 of 2) page
Book: Mayo Clinic Family Health Book, 4th Edition Newsletter: Mayo Clinic Health Letter Give today to find cures for tomorrow
See Also
Warfarin: Any harm in long-term use? Blood thinners: Can I still get blood clots?