HF 8406

Warfarin

Warfarinsodium is a type of blood thinner. It is used to stop blood clots from forming. It can also stop an active blood clot from getting bigger. Some brands include Coumadin and Jantoven. This Health Facts for You will review warfarin instructions for your child.

How It Is Taken

Your child should take the warfarin as prescribed and take it the same way and at the same time each day. This includes whether your child takes it with or without food.

Do not have your child repeat a dose or take an extra dose the next day if they miss a dose. Use a pill box so you know that your child has taken the warfarin for the day.

INR

INR (international normalized ratio) is a type of blood test that will tell us how long it takes the blood to clot. Many things can affect INR such as food, drinks, supplements, and medicines. Your child will need to have the INR checked to help find the proper dose of warfarin for your child.

Dosage

The bottle for the warfarin may not show the correct dose. The dose will change depending on your child’s INR level. All caregivers need to be aware of the current dosing routine.

Bleeding

Sometimes warfarin can cause bleeding. We want your child to stay active, though some sports may need to be avoided or modified. Talk with your child’s doctor about safe activities.

For those on warfarin, it is important to wear a helmet and other protective gear when:

  • Riding bikes or scooters

  • Sledding, skiing, or snowboarding

  • Other high risk activities

If your child has bleeding, seek medical care if bleeding doesn’t stop a few minutes after injury or if you notice bruising. If a child injures their head or stomach, watch them closely. If you are concerned about internal bleeding, seek medical care right away.

Minor Bleeding

Talk to your warfarin manager if you have concerns about bleeding. Common signs of minor bleeding include:

  • Gums that bleed while you brush your teeth

  • Bruising more than usual

  • Broken blood vessel in your eye that does not cause pain or vision changes

  • Occasional nose bleeds

  • Prolonged and heavier than normal menstrual (period) bleeding

  • Prolonged bleeding after minor cuts

Major Bleeding

Signs of major bleeding include:

  • Any bleeding that lasts more than 10 minutes that you can’t stop

  • Coughing/vomiting up blood

  • Frequent nose bleeds, bleeding gums, or unusual bleeding

  • Unexplained bruising

  • Red or dark brown urine

  • Red, black, or tarry stool

  • Severe headache

  • Severe stomach pain

Target INR Range

The target INR range depends on the reason for warfarin. Most people have a target INR range of 2-3 or 2.5-3.5. Your child’s doctor will tell you what the target INR range is.

INR Testing

When first starting warfarin, your child will need their INR tested 2-3 times per week. Your child may be able to test less often once the INR and dose are more constant. Then, testing may decrease to once per month. Keep all scheduled INR checks. Call if you need to reschedule.

Food and INR

Some foods can affect the INR levels. Vitamin K is one of these and is common in many foods, such as green leafy vegetables. Large amounts of vitamin K foods can lessen the effects of warfarin. When eating these foods the most important thing is to eat them in consistent amounts. Do not eat a lot one week and then none the next week. Some foods high in Vitamin K include:

  • Green tea

  • Brussels sprouts

  • Cabbage

  • Broccoli

  • Asparagus

  • Dark green lettuce/greens (kale, spinach, Swiss chard)

  • Soybeans, edamame

  • Nutritional shakes/weight loss drinks

Medicines and Supplements

Tell the cardiology doctor before starting any new medicines. This includes supplements and antibiotics. Many common medicines can affect the INR level. If your child needs antibiotics or other medicines or supplements, the warfarin dose may need to be adjusted. The INR will need to be checked more often. Always tell your child’s care team that they are on warfarin.

Surgical, Dental, or Other Procedures

Your child may need to stop taking warfarin before certain procedures. Have your doctor call the clinic that manages your warfarin if they want you to stop taking . Sometimes there is a different type of medicine that you will take around the time of your procedure.

Illness

Illness can change the response to warfarin. Tell your doctor or clinic if your child has:

  • Started taking an antibiotic

  • Nausea or vomiting for 2 days in a row or more

  • Diarrhea for 2 days in a row or more

  • Severe flu-like symptoms

  • Stopped eating or food intake has changed due to illness

Medical Alert Bracelet

Your child should wear a medical alert bracelet, or something similar, so that in case of an emergency, health care providers know your child is on Warfarin.

Blood Clots or Stroke

Warfarin is often used to stop or treat blood clots or to prevent a stroke. You should still be aware of the signs and symptoms of blot clots and strokes. Symptoms of a stroke or blood clot include a sudden onset of:

  • Pain/tenderness or swelling in a limb

  • Chest pain, shortness of breath

  • A headache (described as the worst headache you ever had)

  • Changes in vision

  • Feeling weak on one side of the body

  • Slurred speech or trouble speaking

  • Confusion

Call 911 right away if you notice any of these signs.