Can you take coumadin and heparin together

Warfarin and heparin work in slightly different ways, but both block the production of certain proteins in your liver that work together to help your blood to clot. Heparin also works by preventing certain cofactors, namely thrombin and fibrin, from working correctly.

By blocking the process early on, both warfarin and heparin ultimately help to reduce blood clots from forming in your body. Warfarin comes in tablet form, and heparin must be given as an injection. The amount of medication needed differs with each person and each situation, and individuals on these medications should be closely monitored by their doctors to ensure that they are being given the correct dose.

Warfarin Coumadin is not safe during pregnancy. It can cause birth defects and fetal bleeding. Women who take warfarin must switch to heparin or low molecular weight heparin before they become pregnant, since heparin or low molecular weight heparin Lovenox, Fragmin do not cross the placenta into the fetus. Do not smoke or drink alcohol while taking anticoagulants.

Smoking increases the risk of blood clots and cardiovascular disease, and cardiovascular disease is the number one cause of death in people with lupus. Alcohol can interfere with the effectiveness of anticoagulant medications, can be harmful to your liver, and can irritate your stomach gastritis , causing bleeding.

Warfarin is the most widely used anticoagulant, but because everyone differs in their physiological make-up, dosage requirements differ from person to person. Blood clotting is a natural protective mechanism employed by the body to seal off damaged blood vessels; any medication that alters this natural protective mechanism must be carefully monitored.

People taking warfarin must obtain a blood test every weeks to ensure that their blood is thinning to the correct degree without bleeding complications. This test the INR, discussed below may be requested several times a week at the beginning of your treatment to ensure that you are started on the correct dose. In actuality, Prothrombin time is the test used, and INR is simply a standardized way for medical institutions to report consistent values for Prothrombin times.

The INR ratio is calculated based on comparison of blood tests against a known standard, and your physician will monitor your warfarin levels based on this INR ratio. Generally, an INR of 2. If possible, avoid oral contraceptives because of increased risk of thromboembolism Monitor INR frequently when oral contraceptives are used concurrently with warfarin. Displaces warfarin from protein binding, inhibits platelet aggregation, causes gastric erosions.

Acute ethanol use may inhibit anticoagulant metabolism. Chronic ethanol use induces liver enzymes. Cirrhosis is associated with reduced warfarin metabolism. Caution patients to drink in moderation and to avoid binge drinking. Because liver damage results in greater sensitivity to warfarin, use lower starting doses. Note that lovastatin Mevacor is more commonly associated with hypoprothrombinemia. Displaces warfarin from protein-binding sites Inhibits warfarin metabolism.

Avoid concomitant administration of warfarin and nalidixic acid. Monitor INR if concomitant use is necessary. Inhibit platelet aggregation Cause gastric erosions. Consider having patients take misoprostol Cytotec to reduce risk of gastric erosions. Dicloxacillin Pathocil and nafcillin Unipen may enhance warfarin metabolism. Inhibit platelet aggregation Cause gastric erosions In large doses, result in hypoprothrombinemic effect. If aspirin is needed, advise patients to use a small dosage mg or less per day.

If possible, avoid concurrent use of warfarin and trimethoprim-sulfamethoxazole. Interaction is probably dose-related and more likely to occur with vitamin E dosages greater than U per day; monitor INR if larger dosages are taken. Effects of oral anticoagulants are directly antagonized by the excessive ingestion of foods or dietary supplements containing vitamin K. Advise patients to eat a consistent diet and to avoid taking large doses of vitamin supplements containing a great deal of vitamin K.

In: Pharmacotherapy self assessment program module 1 cardiovascular. Kansas City, Mo. Retrieved September from the World Wide Web at http:www. Additional information derived from Warfarin.

In: Drugdex. Englewood, Colo. Often, the interacting drugs that pose the greatest problem are those used for short-term indications. Antibiotics are a common example. When interactions occur, close monitoring or the use of alternative antimicrobial agents is appropriate. Warfarin is more likely to be used safely by a patient who is aware of the potential for drug interactions, understands the rationale for monitoring and can identify the symptoms of warfarin toxicity early.

Patient instruction booklets in English and other languages are available from several sources. Most local pharmacies supply similar information to patients. When used appropriately, warfarin is a highly effective and safe medication. To maximize the safety of warfarin therapy, the physician should do the following: Identify the therapeutic goal. Estimate the chronic maintenance dosage based on the presence of factors associated with hyperresponsiveness or hyporesponsiveness, such as concomitant drug use, liver disease and poor nutrition.

Initiate therapy at the patient's anticipated maintenance dosage. Loading doses are not necessary. Make any necessary adjustments by looking at the cumulative weekly dosage and adding or subtracting 10 to 20 percent evenly over the week. Already a member or subscriber? Log in. Interested in AAFP membership?

Learn more. He also serves as clinical assistant professor at the University of Maryland School of Pharmacy, Baltimore. Horton graduated from the University of Pittsburgh School of Pharmacy and earned his doctor of pharmacy degree from Duquesne University, Pittsburgh. Bushwick graduated from the University of Maryland School of Medicine, Baltimore, and completed a family practice residency at York Hospital.

Address correspondence to Jon D. Horton, Pharm. George St. Reprints are not available from the authors. Establishing an outpatient anticoagulation clinic in a community hospital. Am J Health Syst Pharm ;—7. Oral anticoagulants: mechanism of action, clinical effectiveness, and optimal therapeutic range. Chest ; 4 Suppl S—46S. National prescription audit: physician specialty report, dispensed data.

Plymouth Meeting, Pa. Retail perspective and provider perspective audit. Agency for Health Care Policy and Research. Life-saving treatments to prevent stroke underused. Press release, September Antithrombotic therapy in patients with mechanical and biologic prosthetic heart valves. Antithrombotic therapy in valvular heart disease. The duration of oral anticoagulant therapy after a second episode of venous thromboembolism.

N Engl J Med. Antithrombotic therapy in atrial fibrillation. Optimal duration of oral anticoagulant therapy: a randomized trial comparing four weeks with three months of warfarin in patients with proximal deep vein thrombosis. Thromb Haemost.

Anticoagulant thrombolytic, and antiplatelet drugs. New York: McGraw-Hill, — Applied pharmacokinetics. Spokane, Wash. Comparison of 5-mg and mg loading doses in initiation of warfarin therapy. Ann Intern Med. Aging and the anticoagulant response to warfarin therapy. Monitoring effects of oral anticoagulants during treatment with heparin. Br Med J [Clin Res]. Ansell JE. Oral anticoagulant therapy—50 years later. Arch Intern Med. Carter BL.

Therapy of acute thromboembolism with heparin and warfarin. Clin Pharm. Am J Health Syst Pharm. Wittkowsky AK. Generic warfarin: implications for patient care [Editorial]. Medical and economic consequences of a blinded oral anticoagulant brand change at a municipal hospital. Pharmacokinetics and pharmacodynamics of warfarin at steady state.

Br J Clin Pharmacol. Hemorrhagic complications of anticoagulant treatment. Anticoagulant-related bleeding: clinical epidemiology, prediction, and prevention. Am J Med. Major bleeding in outpatients treated with warfarin: incidence and prediction by factors known at the start of outpatient therapy. Albers GW. Atrial fibrillation and stroke: three new studies, three remaining questions. Risk factors for stroke and efficacy of anti-thrombotic therapy in atrial fibrillation: analysis of pooled data from five randomized controlled trials.

Risk factors for complications of chronic anticoagulation: a multicenter study. Bleeding complications to oral anticoagulant therapy: multivariate analysis of treatment years in outpatients.

J Intern Med. The risk for and severity of bleeding complications in elderly patients treated with warfarin. Stroke prevention in atrial fibrillation study: final results. An analysis of the lowest effective intensity of prophylactic anticoagulation for patients with nonrheumatic atrial fibrillation. Adjusted-dose warfarin versus low-intensity, fixed-dose warfarin plus aspirin for high-risk patients with atrial fibrillation: Stroke Prevention in Atrial Fibrillation III randomised clinical trial.

Richard W. Sloan, M. Hospital and clinical associate professor in family and community medicine at the Milton S. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.

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Feb 1, Issue. Warfarin Therapy: Evolving Strategies in Anticoagulation. Warfarin is the oral anticoagulant most frequently used to control and prevent thromboembolic disorders. TABLE 2 Risk Factors for Hemorrhagic Complications of Anticoagulation Therapy Age greater than 65 years 23 Age greater than 75 years with concomitant atrial fibrillation intracranial hemorrhage 24 , 25 History of gastrointestinal bleeding 20 Comorbid disease states 26 Hypertension 20 , 27 Cerebrovascular disease 20 Serious heart disease 4 , 20 Renal insufficiency 20 Information from references 4 , 20 , and 23 through Amiodarone Cordarone Moderate Delayed Excellent Decreases warfarin metabolism within a week of coadministration; effect may persist for 1 to 3 months after discontinuation of amiodarone May induce hypothyroidism or hyperthyroidism A 25 percent reduction in the warfarin dosage is recommended when amiodarone is initiated.

Antithyroid drugs Moderate Delayed Fair Hyperthyroidism results in metabolism of vitamin K clotting factors and increased sensitivity to oral anticoagulants Monitor INR when antithyroid medications are added or withdrawn. Barbiturates Major Delayed Excellent Increase warfarin metabolism and frequently reduce hypoprothrombinemic effect of warfarin Monitor INR when barbiturates are added or withdrawn; the addition of warfarin in patients stabilized on a chronic barbiturate regimen is of less significance.

Blood thinners are medicines that prevent blood clots from forming. They also keep existing blood clots from getting larger. Clots in your arteries, veins, and heart can cause heart attacks , strokes , and blockages. You may take a blood thinner if you have. There are two main types of blood thinners.

Anticoagulants such as heparin or warfarin also called Coumadin slow down your body's process of making clots. Antiplatelet drugs, such as aspirin, prevent blood cells called platelets from clumping together to form a clot.

When you take a blood thinner, follow directions carefully. Blood thinners may interact with certain foods, medicines, vitamins, and alcohol.