Thrombosis FAQ’s

Question: What medications should I not take with my Coumadin?

Answer: Unless specifically instructed by your doctor, you should avoid medications that affect other aspects of your clotting system, such as aspirin. Some people on Coumadin® are instructed to take anti–platelet agents due to their high risk of clotting. There are many medications that may increase the blood thinning effects of your Coumadin. Some antibiotics may also influence your Coumadin. Be sure to inform your doctor of all the medications you are taking prior to starting Coumadin. When taking medications that may interact with Coumadin and affect the level of anticoagulation, patients may need to check their level of anticoagulation (INR – international normalized ratio) more frequently in order to maintain the correct range.

Herbal medications, although available without prescription, may also affect patients’ level of anticoagulation. For example, supplements that may affect clotting include ginseng, ginko biloba, bromelain, flaxseed, fish oil, vitamin E (in large doses), garlic, ginger and bilberry fruit. Check with your physician before starting any herbal medications.

Question: I was told I can’t eat any vitamin K foods when I’m on Coumadin. Is this true?

Answer: Although Coumadin works through interference with the vitamin K pathway (which is important in some of the body’s clotting factors), anticoagulation patients on Coumadin do not have to avoid all vitamin K–containing foods. However, eating large amounts of foods with vitamin K can decrease the effectiveness of your Coumadin. Patients should therefore eat approximately the same number of servings of foods with Vitamin K per day in order to maintain a consistent INR. Drastic changes in diet such as attempts to lose weight by eating more green leafy vegetables or cutting out all green leafy vegetables will affect patients’ level of anticoagulation. In the first case, too many salads will decrease your INR; and in the second instance, cutting out all vitamin K foods will increase your INR. So patients should make sure they eat the same amount of green leafy vegetables every day.

Question: What are the symptoms of a blood clot?

Answer: The symptoms of a blood clot (thrombotic episode) relate to where the blood clot is located, the size of the clot, and whether the clot breaks off and travels to another part of the body. For example, a blood clot in the lungs is known as a pulmonary embolus; a clot found deep in a leg is called deep vein thrombosis; in the brain, it’s called a stroke. Some of the symptoms of a pulmonary embolus include chest pain, shortness of breath and coughing up blood. Symptoms of a deep vein thrombosis (clot) include swelling, pain, and perhaps redness in the affected leg. People having a stroke may experience a sudden headache and facial and limb numbness, as well as weakness or paralysis, particularly on one side of their body; difficulty with vision, walking or maintaining balance may also occur, and the stroke victim may appear to be confused; occasionally, seizure or loss of consciousness will occur.

Question: Are all clotting problems inherited?

Answer: Although physicians are now able to determine the cause of excessive clotting in some patients and families, physicians are still not able to make this determination in all cases. This means that there is more to be understood about why some persons and families have thrombophilia (clotting problems).

Genetic thrombophilia is an inherited abnormality that leads to an increased risk of thrombosis (clotting) throughout a person’s life. The most common of this family of inherited disorders is factor V Leiden. Please note that not all thrombosis is genetic; clotting disorders can also be acquired, meaning they may develop at any time without a genetic tendency.

Question: If I have been diagnosed as an adult with an inherited clotting disorder, such as factor V Leiden, should other members of my family be tested if they haven’t personally had a blood clot?

If you have been diagnosed with a genetic thrombotic disorder such as factor V Leiden, your children and other potentially affected individuals (members of your immediate family) should be tested. They should visit your hematologist to have a blood sample drawn and analyzed for the factor V Leiden disorder.

Testing of family members is good preventive healthcare management. It allows family members to make informed decisions about their health and gives their medical provider important information that may be needed in certain circumstances, such as pregnancy, decisions about birth control and surgery.

Question: If I have had an extensive deep vein thrombosis (DVT), is it common to have symptoms of swelling, pain, changes in skin color and varicose veins?

Answer: The symptoms of chronic swelling, swelling with standing, redness, dilated blood vessels and pain are relatively common after a significant thrombosis has occurred. These symptoms are collectively referred to as post–phlebitic syndrome (PBS). PBS may occur for months following the formation of a clot or may become chronic after repeated clots or if the first clot was large.

It may be hard to determine whether the symptoms of leg swelling are from a new clot or from PBS. Symptomatic management includes using a compression garment (often prescribed to provide a specific degree of pressure), maintaining circulation (blood flow) with standing and moving on a regular basis, avoiding long periods of standing still, drinking plenty of fluids and elevating the affected area. Seeking your physician’s advice is important if symptoms continue, change, or you are concerned that a new clot has developed. Tests are now available to help distinguish old clots from new clots.

Question: How common is thrombosis?

Answer: Thrombosis is a very common medical problem. According to the American Thrombosis Association, 5 to 20 million cases of venous thrombosis occur annually in the United States. The American Heart Association estimates that each year, approximately two million people in the United States experience a deep vein thrombosis (DVT). In addition, nearly half of the patients with DVT experience long–term health problems that affect their daily lives and require millions of dollars of treatment.

Emboli (clots that break off and travel in the blood stream and are forced into a smaller vessel, thereby interfering with blood flow) from deep vein clots are a leading cause of death in hospitalized patients. Every year, 200,000 to 300,000 patients develop this form of clot for the first time during a hospitalization. Nearly 40% of these patients suffer pulmonary emboli (a clot that travels to a lung and obstructs blood flow to the organ), which results in death in 30% of the cases. Recent research shows that these disorders contribute significantly to morbidity and mortality (disability and death) in the United States. Each year, more than 600,000 Americans die from abnormal blood clots.

Factor V Leiden is the most common inherited abnormality causing an increased tendency to clot. It affects approximately 5% – 7% of the Caucasian population of European descent in the United States. Many of these people have not yet experienced a clot; some never experience a clot

Question: Who has thrombophilia?

Answer: Thrombophilia affects a large number of people worldwide. Persons who experience episodes of thrombosis, either as an isolated event or as a repeated event, may be affected with a thrombophilic disorder. There are people who have inherited an abnormality, such as factor V Leiden or activated protein C resistance, who have an increased tendency for thrombosis but may never personally get a blood clot. They may, therefore, have a known clotting problem, but never experience a thrombosis.

Both children and adults can have thrombophilia, but it is more commonly diagnosed during the teen and adult years due to normal changes in the blood that occur with growth and aging. Both men and women can have thrombophilia. In fact, women who have thrombophilia can have clotting problems during pregnancy, associated with the use of birth control pills, or during hormonal replacement therapy.

Question: Is there a reason to see a specialist for thrombosis?

Answer: A multidisciplinary medical staff that includes a hematologist, nurses, a nutritionist, genetic counselor, physical therapist and social worker can provide an individual affected with thrombotic disease a greater ability to understand and manage his/her medical condition. Comprehensive hemophilia treatment centers (HTCs) are staffed by multidisciplinary teams expert in the care of persons with blood disorders. These teams are well equipped to address the needs of persons affected with clotting disorders.

Accurate diagnosis of the clotting abnormality that may have contributed to the development of the thrombosis is essential to your and your family’s healthcare. The optimal length of time a patient takes a blood thinner is affected by the underlying cause of the clotting, the specific clotting event the individual has experienced, the age of the patient and the family history. Hematologists specializing in thrombosis diagnosis and treatment have the expertise to effectively manage patients’ blood clotting therapy.

Coumadin Questions

Question: When is Coumadin taken?

Answer: Coumadin should be taken daily, in the evening, at approximately the same time every day. If you forget to take a dose, contact your medical provider for specific instructions.

Question: What is an INR?

Answer: The effect of Coumadin used to be reported by the prothrombin time (PT) test, but now the INR is used. An INR (international normalized ratio) is a number derived from the prothrombin time that monitors how well the Coumadin or warfarin (Coumadin’s generic name) is working. It measures “blood thinness.” Ideally, most patients’ INRs should be between 2–3. Higher INRs indicate your blood is too thin; INRs below 2 indicate your blood is too thick. This test is done by either venipuncture or by an instrument that provides an INR score from a blood sample taken from a finger stick.

Question: How often should my anticoagulation level be monitored?

Answer: Monitoring of the INR will vary based upon how well patients respond to their Coumadin dose and other medical problems. Some patients require weekly monitoring, while more stable, long–term patients may be monitored from every other week to once a month.

Question: What information should be provided to me about my anticoagulation?

Answer: Your hematologist as well as your primary care physician should have educational material on hand about the use and monitoring of Coumadin. You should know your target INR range and the results of your INR testing. Keeping a record of your INRs and Coumadin dose will help you be a better partner in your healthcare.

Question: Why would my physician prescribe the use of low molecular weight heparin (LMWH) for me instead of Coumadin?

Answer: There may be instances when your doctor places you on low molecular weight heparin instead of Coumadin. These situations may include but are not limited to: patients that have clotting events while on Coumadin, patients who are pregnant, patients with new or very large clots, and patients who are about to undergo surgery or dental work. The use of LMWH requires intensive patient education before the start of therapy. This should be coordinated through your physician’s office.