They are not quite interchangeable and caution is
required in prescribing by the doctor and
dispensing by the pharmacist. Both drugs come as
1 mg and 5 mg tablets, but Coumadin is also
Warfarin: an anticoagulant or
available as a 2 mg tablet, while Marevan is
“blood thinner” Blood tests
The widely used drug Warfarin is often referred to
Samples of blood are required for laboratory testing
as a “blood thinner”. It does not thin the blood; it
every couple of days when the drug is first
stops blood from clotting. It is not like a paint
introduced. We al vary in our response to the drug
thinner or liquid paper thinner. It is a drug which
(as determined by PT or INR values). When the
blocks specific processes within the body,
required level is achieved, tests may initial y be on
interfering with the availability of Vitamin K. It is
a weekly basis for the first month or so, and then
therefore referred to as a Vitamin K antagonist.
Vitamin K is essential for the proper formation of
blood clots. An under-dose of Warfarin wil not stop
Long term regular testing is needed for several
blood from clotting. Taken in overdose, bleeding
reasons. There may be interactions with other
may occur at any susceptible site in the body.
drugs introduced for some different purpose.
Background
complementary therapies: the effects of Warfarin
Fifty years ago, a famous London cardiologist (with
are increased by ginger, garlic and ginseng. Other
the voice of a Welsh preacher) giving a medical
herbal treatments may also interfere with the
lecture in the USA, startled his audience, opening
effectiveness of the drug. PT and INR are also
his address thus- “Anticoagulants?- rat poison!”
influenced by Vitamin K intake in certain foods. A
Warfarin in large dose (for rats and mice) is indeed
list of foods which may interfere with the effects of
a highly effective rodent poison. The rodents bleed
Warfarin may be available with the tablets, or from
the pharmacist, or prescribing doctor. Most people
achieve the desired level of PT or INR and maintain
How is Warfarin taken?
it with a steady dose thereafter, provided that they
Human administration needs to be adjusted to
have regular habits, control ed alcohol consumption
ensure that the level of effect lies in a range
(alcohol increases the anticoagulant effect of
between where the dose is effective and where it
should not lead to unwanted bleeding. Laboratory
tests give us the measure of effectiveness in an
Who is prescribed Warfarin?
individual patient on a specific day. The measure is
Some people need an anticoagulant on a long term
cal ed the prothrombin time (PT) or is converted to
or permanent basis. This long term medication is
the International Normalised Ratio (INR). The
usual for people who are likely to develop blood
normal INR is 1. The therapeutic range of INR is
usual y 2 to 3. Warfarin is taken in tablet form. In
Australia, there are two major preparations,
The drug is commonly used in those who have the
pulse irregularity of atrial fibril ation, those with
The views expressed are those of the author and not necessarily those of the Heart Research Centre
established chronic heart failure who are breathless
and the risk of subsequent stroke or other crises
and have enlarged heart chambers, those with
owing to a portion of blood clot coming free and
valve abnormalities and an enlarged heart and
lodging in the brain or elsewhere. Ful y monitored
those who have artificial heart valves (prostheses)
and properly control ed, the gains for the many far
replacing previously damaged, narrowed or leaking
outweigh the possible hazards for the few. Is this
heart valves. Al of these conditions are much more
another balancing act? No, this is good preventive
common amongst the elderly, a rapidly increasing
medicine and patient care. Like al medications,
portion of the population. Thus medication with
Warfarin should be prescribed, dispensed,
Warfarin is also increasing rapidly. Does that
matter? Yes, it does. The older one is, the more
likely the blood vessels are to be damaged easily,
such that bleeding may occur anywhere. Bleeding
may be into the stomach if there is an ulcer, into
the urine if there is a kidney stone, into the bowel
or into the brain causing a stroke if the blood
pressure is high. Thus we have increasing risk of
For more information go to our website
bleeding with advancing age, increasing risk of
www.heartresearchcentre.org
blood clotting with advancing age, increasing
sensitivity to drugs including Warfarin with
advancing age and increasing chance of drug
interactions with advancing age as we take more
medications for other conditions related to ageing.
This seems to present a dilemma, a medical
balancing act. It is not too bad. Blood tests reveal
any trends in PT or INR to be changing (one way or
the other). If the PT and INR is too low, the
Warfarin dose is increased. If the PT or INR is too
high, the Warfarin dose can be reduced: also there
Some people require Warfarin for a period of only
weeks or months. These include those with deep
vein thrombosis (DVT) in the legs or elsewhere and
people who have had a blood clot move from the
Is Warfarin effective and truly valuable?
In the face of al of the above, does Warfarin
treatment have overriding benefit? The answer is
yes, it does. Ful y control ed, the drug markedly
reduces the formation of blood clots in the heart
The views expressed are those of the author and not necessarily those of the Heart Research Centre
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8401 W. DODGE RD., SUITE #115, OMAHA, NE 68114; 1-800-222-1222; (402) 955-5555 Steven A. Seifert, MD, Medical Director Nebraska Regional Poison Center _____________________________________________ The Emergency Department is often the front line in dealing with significant toxic exposures. Here’s an update. 1) We’ve had a name and sponsorship change. We are now the Nebraska Regional Po