Sir  na Vascular Center

The length of time you are on warfarin varies patient to patient. Some people require warfarin for only a few months; others need lifelong treatment. This decision may be made in concert with your vascular surgeon, primary care physician, hematologist and cardiologist.

When you first start warfarin, it typically takes several days for the medication to take effect. The level in your blood stream is monitored with a blood test called protime (PT) or international ratio (INR). The goal INR is typically 2-3. During the initial start-up time, you are also started on or "bridged" with an injectable medication called Lovenox (Enoxaparin). This medication is administered by you or your family twice a day and is continued until the warfarin level is theraputic. It may also be used at times when your INR drifts too low.

When you first start warfarin, the INR may need to be checked every day or every other day. Once you reach a stable level of warfarin, it is checked less frequently (once or twice a month). Typically, you identify a lab near you where your "standing order" for the INR is kept. If you are going to be on warfarin for a while, sometimes purchasing a home monitor and doing the blood test yourself at home is a good option. Always take your warfarin at night and always have the INR drawn in the morning. That way, your lab results are available by the afternoon, so that we can adjust your level if we need to. If you are working with our office to monitor your warfarin, please make sure we have a reliable way to reach you on the days you have your INR drawn.

Side effects of warfarin include bleeding problems, rash or hives, easy bruising, nausea, flu like symptoms/fatigue, joint or muscle aches, diarrhea, gas, hair loss, and change in the sensation of taste.  Rarely, starting warfarin is associated with painful red or black sores in the skin of the legs, buttock or breasts which can lead to large open wounds (warfarin necrosis). The chances of developing this complication is mitigated by use of Lovenox to bridge the coumadin.

If you develop uncontrolled bleeding on warfarin, or if you are involved in a major trauma or suffer a head injury while taking this medication, you should seek immediate medical attention.

There are other newer oral anticoagulants which are currently being studied as alternatives to warfarin (Arixtra, Xarelto, Pradaxa). They are not yet FDA approved for all applications, but are used in some patients who cannot take warfarin.