DEAR DR. GOTT: My question is simple but serious. The blood thinner Coumadin is ordered for a 94-year-old lady. She is up and about and mostly self-care. Hospice sees her but she frequently complains of high blood pressure and a little chest discomfort. MOST FRIGHTENING is the leakage of blood so that her forearms are now very dark with seepage of blood under the skin, increasing up her arms. They are dark up to her elbows. Her blood pressure remains around 160/80. She does have ankle edema but wonders, realistically, if blood is also seeping elsewhere in her body and not showing up as it does on the thin skin on her arms. Her doctor does not discuss this. She is in home health care and seen once a week. I did write to you once and am sorry if I have mistakenly used your email.
DEAR READER: I hope you and other readers will continue to send any correspondence to me at www.AskDrGottMD.com so, no apology is necessary.
Coumadin and its generic counterpart warfarin is an anti-coagulant that lowers a person’s possibility of developing blood clots in veins and arteries of the body. Therefore, the medication is also prescribed to prevent heart attacks and strokes. This medication can cause a patient to bleed more easily, especially if he or she has a history of hypertension, severe heart or kidney disease, cancer, a history of bleeding problems or has thin skin as seen with the normal aging process.
Further, serious medical problems can occur if some prescription drugs, over-the-counters, or even herbal products are taken with Coumadin, so it is extremely important your physician(s) are aware of everything taken. What we sometimes fail to consider is that we may be seeing a primary care physician, a cardiologist and perhaps even a rheumatologist or other specialist. We take it for granted that each physician is in contact with the others and keeps them up-to-date on medications; yet often times they are completely in the dark as to what someone else has prescribed. By the time we get to a dentist, surgeon, or other specialist for even a minor procedure such as tooth cleaning or cyst removal, neither specialist may know you are on an anti-coagulant – and they must!
There are specific conditions such as kidney disease, hypertension, gastrointestinal bleeding, severe heart disease, and others that can cause a person to bleed more easily if they are placed on Coumadin. Therefore, it is critical that a full medical history be available for anyone involved with your care.
Doses should be taken precisely as ordered by the prescribing physician and not modified at will. Your physician will order laboratory testing periodically to assure the proper dose is given. Dosing orders may appear hit and miss to a patient who wonders why a competent physician can’t get things right the first time. Having said that, a physician prescribes what he or she thinks is correct but each patient responds differently. Lab results may mandate a dosing modification that results in timely lab testing and possible re-modification. And so it goes until the right amount is given.
Coumadin should be taken at the same time every day, often in the evening, with or without food although certain foods and beverages such as cranberry juice, alcohol and those rich in vitamin K should be avoided. Patients should not consider a weight loss program while on the medication. The drug should be stored at room temperature, away from excessive moisture or heat.
Should severe and unusual symptoms present, such as chest tightness, tarry or blood stools, hives, difficulty breathing, abdominal pain, fever, severe but sudden extremity pain, vomiting of a coffee ground appearing substance, or other side effects, the prescribing physician should be contacted promptly.
And, at long last, patients with this or other serious medical conditions should wear a medical alert tag or carry an identification card. While we think we are safe and in-control, we never know when an unexpected occurrence can happen. In this way, you can help others to help you.
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