Anticoagulation Management

University of Maryland
Harford Memorial Hospital
(1st floor inside the lab)
Phone: 443-843-5570
Fax: 443-843-5563
University of Maryland
Upper Chesapeake Medical Center
Pavilion II (5th floor)
Phone: 443-643-3232

Fax: 443-643-3299

 

For Optimum Medication Therapy and Safety

University of Maryland Upper Chesapeake Health (UM UCH) comprehensive approach to Anticoagulation Management will help to decrease an individual’s risk of developing complications and will improve your health through increased patient education and close monitoring of your medication therapy.

Our Anticoagulation Service provides an outpatient-based monitoring program for individuals who have been prescribed oral anticoagulation medications such as Coumadin (warfarin). You will receive education about your disease/condition and your medications. If medication changes are made, the pharmacist can provide you with a new prescription. Each appointment will include blood work (via a fingerstick), and one-on-one consultation and education with one of our  pharmacists who is specifically trained in anticoagulation management. The results of your blood work will be used to adjust the dosage of your anticoagulation medication for optimum therapy and safety.

Our patients will receive education about their medication, their prescriptions will be called into the pharmacy of their choice, and follow-up appointments will be scheduled.

Referral, Pre-Registration and First Appointment

Your physician will need to complete an Anticoagulation Request for Service form. This form will be submitted to our Anticoagulation Services, and you will be contacted by one of our team members to schedule your first appointment. Before the day of your first appointment, you will be contacted by a team member from the UM UCH ScheduleFirst department to complete pre-registration by phone.

Please arrive at the Anticoagulation Services department 15 minutes prior to your first appointment to allow time for the registration process. For your first appointment, you will need to bring a photo ID, insurance cards, and a list of your medications to include prescription, over-the-counter medications, and supplements. Arriving 10 minutes prior to subsequent appointments is greatly appreciated.

Managing Nose Bleeds


Nose Bleeds can be a consequence of anticoagulation therapy.  Minor nose bleeding events may be managed at home by the patient or caregiver.  Serious nosebleed events may require immediate medical attention.

  1. Remain calm.
  2. Sit in a chair with head forward, keeping mouth open so that blood or clots will not block airway, and to avoid choking.
  3. Squeeze sides of nose together at the bridge, below the bone, for about 15 minutes.
  4. If possible, place a cold cloth or ice against the nose and face to decrease bleeding. Do not plug or block the nostrils.
  5. After 15 minutes, release pressure. Avoid irritation to nose. If bleeding continues, seek medical attention.

Over the Counter Medications and Warfarin

Medications to Avoid
Medications That You Can Safely Take
Actron
Advil
Aleve
Alka-Seltzer
Ascription
Aspirin
Bayer
Bufferin
Ecotrin
Empirin
Excedrin
Ibuprofen
Ketoprofen
Motrin
Naprosyn
Naproxyn
Nuprin
Orudis KT
Pepto-Bismol
Acetaminophen, APAP (Tylenol)
Allerest
Benadryl
Benylin cough syrup
Chlorpheniramine
Chlor-Trimeton
Coricidin HBP
Diphenhydramine  (Benadryl)
Drixoral
Guaifenisen  (Robitussin, Mucinex)
Loperamide (Imodium)
Maalox *
Mylanta *
Robitussin cough syrup
Tums/ Rolaids

* Note: if you use antacids, such as Maalox or Mylanta, take them at least two hours before or two hours after taking your warfarin
** Some of the above products may not be recommended for other medical conditions you may have, please contact your physician before using. 

 
Herbals/Supplements that Effect Warfarin ***
Alfalfa
Dandelion         
Goldenseal 
Saw Palmetto      
Aloe/aloe gel  
Don quai           
Green Tea
St John’s Wart
Aspen
Feverfew           
Horse Chestnut   
Sweet Birch        
Black Cohosh
Garlic                
Licorice Root       
Sweet Woodruff  
Bromelain
German Sarsaparilla
Meadowsweet     
Tamarind             
Cayenne
Ginger              
Policosanol          
Turmeric             
Chamomile
Ginseng            
Poplar                 
Vitamin E           
Clove
Gingko Biloba  
Red Clover          
Yarrow
Coenzyme Q10
Grape Seed       
Reishi                 
Willow Bark      
*** The above herbal agents increase risk of bleeding unless otherwise noted by a downward arrow.  Please note that the above is not a comprehensive list.  Please consult your pharmacist if you are taking a product that is not listed above. 
Prescription, non-prescription, over-the-counter, and herbal medications may interfere with warfarin, especially antibiotics. Be sure to inform all of your health care providers that you are taking warfarin, so that they will know which medication can be prescribed safety for you.

Vitamin K and Warfarin

  • Vitamin K is responsible for the formation of clotting factors which help the blood to clot and prevent bleeding.
  • Warfarin stops the production of vitamin K.
  • By blocking vitamin K production, warfarin may help to stop harmful clots from forming or from getting larger.
  • Vitamin K is made in your liver but is also in many foods such as dark, leafy vegetables.
  • Changes in the amount of vitamin K in your diet may cause fluctuations in your INR (calculated measurement of the time it takes your blood to form a clot).
    • Increased vitamin K may DECREASE your INR
    • Decreased vitamin K may INCREASE your INR

Your Diet and Warfarin

  • Large changes in the amount of vitamin K you eat may affect the way your warfarin works. 
  • It is important to keep your diet CONSISTENT so the amount of vitamin K you eat is CONSISTENT which will help maintain a CONSISTENT and stable INR.
  • Please contact the clinic before you make major changes to your diet.

Vitamin K Rich Beverages

  • V8® juice
  • Green teas
  • Herbal Teas
  • Nutritional supplements (Boost®, Ensure®, Glucerna®, Carnation® drinks, Slim-Fast®), Soy milk

Vitamin K Rich Foods

  • Asparagus
  • Broccoli
  • Brussel sprouts
  • Cabbage/Sauerkraut
  • Cauliflower
  • Cole slaw
  • Collard greens
  • Canola Oil
  • Endive
  • Kale
  • Lettuce (romaine)
  • Liver
  • Parsley
  • Soy beans
  • Spinach
  • Turnip greens
  • Watercress

Anticoagulation Therapy and Stroke Prevention

Anticoagulant medication, such as warfarin (Coumadin, for example), is highly effective in preventing stroke and death due to stroke in people with atrial fibrillation. However, it may not be suitable for everyone. Consider the following when making your decision:

  • Anticoagulant medication, such as warfarin, provides the best protection against stroke.
  • Almost everyone who has atrial fibrillation should take warfarin. The only people with atrial fibrillation who may not benefit from taking warfarin are people with lone atrial fibrillation who are younger than 65 and have no other risk factors for stroke, or people with chronic kidney disease, recent surgery or head trauma, a history of gastrointestinal bleeding, or alcoholism.
  • If you are going to have cardioversion, your doctor will recommend that you take anticoagulant medication for 3 weeks before and for at least 4 weeks after cardioversion, to reduce the risk of stroke.
  • If you have lone atrial fibrillation and are younger than 60, you can take 325 mg of aspirin daily instead of warfarin.
  • If you are at risk for a stroke, aspirin can help prevent a stroke. But aspirin does not work as well as warfarin.
  • When taking anticoagulants, you are required to have regular blood tests to assess your risk for problem bleeding.

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