You should also tell anyone else involved with your care, such as an anticoagulant nurse, if you need an operation so they can make arrangements.
You can continue to take part in non-contact sports, such as running, athletics, cycling and racquet sports. However, make sure you wear protective clothing, such as a cycle helmet. Tell your GP or anticoagulant nurse if you're going on holiday, in this country or abroad, and arrange to have your INR checked before you go. If you're going to be away longer than a month, you may need to arrange to have your INR checked while you're away.
Make sure you have enough warfarin tablets to last for the duration of your trip. Body piercings aren't recommended while taking warfarin because of the increased risk of bleeding and risk of infection. Home Tests and treatments Medicines and medical aids Types of medicine Warfarin. Introduction Warfarin is the main oral anticoagulant used in the UK. To produce some of the clotting factors, the liver needs a good supply of vitamin K.
When warfarin is prescribed Anticoagulant medicines, such as warfarin, are often prescribed for people who've had a condition caused by a blood clot , such as: a stroke a heart attack deep vein thrombosis — a blood clot within a deep vein in the body, usually in a leg pulmonary embolism — a blood clot in the lungs Warfarin may also be prescribed for people at an increased risk of developing harmful blood clots, such as those with: a replacement or mechanical prosthetic heart valve an irregular heart rhythm, known as atrial fibrillation a blood clotting disorder, such as thrombophilia an increased risk of blood clots following surgery Taking warfarin It's very important that you take warfarin exactly as directed.
The international normalised ratio INR is a measure of how long it takes your blood to clot. Missed doses If you usually take warfarin in the morning and forget to take it at your normal time, take it as soon as you remember and continue as normal.
Who shouldn't take warfarin The following people shouldn't take warfarin: pregnant women — it can affect the development of the baby people with uncontrolled high blood pressure severe hypertension people with a high risk of internal bleeding — for example, those with a stomach ulcer people with a bleeding disorder — such as haemophilia Side effects of warfarin Bleeding is the main side effect associated with warfarin, as it slows down the blood's normal clotting ability.
You should therefore seek medical attention if you: pass blood in your urine or faeces pass black faeces have severe bruising have long nosebleeds — lasting more than 10 minutes have bleeding gums cough up blood or have blood in your vomit experience unusual headaches have heavy or increased bleeding during your period, or any other bleeding from your vagina in women Take extra care to avoid cutting yourself while taking anticoagulant medication because of the risk of excessive bleeding.
For example, you should: take care when shaving and brushing your teeth wear protective clothing when gardening, sewing or playing contact sports use insect repellent to avoid insect bites or stings Seek urgent medical attention if you're taking warfarin and you: have a fall or accident experience a significant blow to your head are unable to stop any bleeding have signs of bleeding, such as bruising Skin rashes and hair loss are also common side effects of warfarin.
Interactions Medicines Warfarin can interact with many other medicines. Ask your GP or pharmacist if you're unsure. When taking warfarin: don't take aspirin , or treatments containing aspirin, unless it's prescribed by a healthcare professional as it could cause bleeding don't take ibuprofen unless it's prescribed by a healthcare professional you can take paracetamol , but don't take more than the recommended dose Herbal medicines and supplements can also interact with warfarin. Food and drink Some food and drink can interfere with the effect of warfarin if consumed in large amounts, including foods that are rich in vitamin K.
Foods containing large amounts of vitamin K include: green leafy vegetables, such as broccoli and spinach vegetable oils cereal grains Small amounts of vitamin K can also be found in meat and dairy foods. They tried to account for confounding factors by adjusting their figures for a wide range of factors, including age, sex, ethnicity, deprivation, smoking, alcohol, blood pressure, other illnesses and use of other medicines. About half of the people taking anticoagulants were diagnosed with atrial fibrillation AF , while half took them for other reasons, such as a previous history of clotting.
The difference in major bleeding rates between warfarin and dabigatran or rivaroxaban was too small to be statistically significant, for people with or without AF. However, for death by any cause all-cause mortality , low doses of 2 of the newer drugs were linked to increases in risk in comparison with warfarin.
Risks of death by any cause for people taking rivaroxaban or low-dose apixaban were also raised compared with warfarin for people without AF. The researchers said the study "showed a decreased risk of major bleeding events associated with the use of apixaban compared with warfarin in both patients with atrial fibrillation and without atrial fibrillation". While they did not explain their findings on increased death rates, they did say: "A greater proportion of the older patients on apixaban and rivaroxaban may have died while still taking anticoagulants but from age-related causes other than ischaemic stroke or venous thromboembolism.
In other words, the drugs and their relative benefits and harms may not have been related to the cause of death. This study adds to evidence that the anticoagulant drug apixaban may cause fewer major bleeding episodes and prevent more DVT than warfarin.
The study suggests this is true for people taking anticoagulants for reasons other than atrial fibrillation. Because it was an observational study, it cannot prove that apixaban causes fewer major bleeds than warfarin.
We would need a randomised controlled trial to prove that. Outside of a randomised trial, doctors are likely to prescribe differently for people at different levels of bleeding risk. We don't know the reason why almost half the people in the study were prescribed anticoagulants.
If you're still in pain after taking paracetamol for 3 or 4 days, speak to your pharmacist or doctor. Do not take aspirin and ibuprofen while you're taking warfarin unless a doctor has said it's OK to.
They increase the chance of bleeding. Do not take St John's wort, the herbal remedy for depression, while you're taking warfarin. Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements. Warfarin is a type of medicine known as an anticoagulant. It makes your blood clot more slowly. Blood clotting is a complicated process involving substances called clotting factors. Clotting factors are made by the liver and help stop bleeding.
They work with blood cells called platelets that trigger the clotting process to make sure your blood clots properly. To make some of the clotting factors, the liver needs a good supply of vitamin K. Warfarin blocks the liver from using vitamin K to make clotting factors. This thins your blood, so it takes longer to clot. This is because everyone reacts differently to warfarin, so it's usual for the dose to go up and down when you first start taking it. The only way to check it's working is to take a blood sample and see how long your blood takes to clot.
If you stop taking warfarin, the rate at which your blood clots will quickly return to what it was before you started taking it. This means you may be at an increased risk of serious problems like strokes , heart attacks , DVT or pulmonary embolism. There are newer anticoagulants, such as rivaroxaban , dabigatran , apixaban and edoxaban. Warfarin does not seem to be any better or worse than newer anticoagulants at treating and preventing blood clots.
But the newer anticoagulants may be more convenient because you do not need to have regular blood tests or be quite as careful about what you eat. You can drink alcohol while taking warfarin as long as you stick to the national guidelines of no more than 14 units a week for men and women. A standard glass of wine ml is 2 units. A pint of lager or beer is usually 2 to 3 units of alcohol. Drinking heavily, especially binge drinking lots of alcohol in one go, is dangerous while taking warfarin.
The alcohol can increase warfarin's effect and make you more likely to bleed. Because of the risk of bleeding, your dose of warfarin may need to be lowered or stopped a few days before you have an operation. It's not usually recommended to have a body piercing or tattoo while you're taking warfarin because of the increased risk of bleeding and infection.
If you still want go ahead, talk to your doctor about your specific risks in case you need antibiotics or adjustments to your warfarin dosage. And let the tattooist or piercer know beforehand that you're taking a blood-thinning medicine. You can still go to your dentist as usual. But tell your dentist if you're taking warfarin before you have any treatment, especially if you need to have a tooth out. You may need to have blood tests before starting treatment to make sure your blood will clot enough to stop any bleeding.
Before taking out a tooth, your dentist will need to know how well your blood is clotting. It's safe for you to have vaccinations, but tell the nurse or doctor that you're taking warfarin. If the vaccine is normally given by injection into the muscle, provided you're up-to-date with your blood tests and the results are within the target range, you can have the injection as normal into muscle.
Or the injection can be given into the layer of fat underneath your skin. This is called a subcutaneous injection. It might help prevent bruising if you press on the injection site for 10 minutes after the vaccination. Warfarin does not affect any type of contraception, including the combined pill and emergency contraception. But you should have an INR blood test when you start or stop taking contraception.
This is to check whether your warfarin dose is still at the right level or needs to be changed. There's no firm evidence to suggest that taking warfarin will reduce fertility in either men or women. But it's not suitable for women who are pregnant or trying to get pregnant.
This is because it may harm the baby. It's thought that cannabis can affect your blood tests and increase your risk of serious bleeding. It's not clear how other recreational drugs like cocaine and heroin affect warfarin. They could be potentially dangerous. Tell your doctor if you think you may take recreational drugs while you're on warfarin. Warfarin does not affect your concentration, so you can drive or ride a bike while you're taking it.
You can reduce your risk of having a blood clot by making changes to your lifestyle, such as:. Page last reviewed: 12 April Next review due: 12 April Warfarin On this page About warfarin Key facts Who can and can't take warfarin How and when to take it Bleeding and what to do about it Other side effects How to cope with side effects Advice about food and drink Pregnancy and breastfeeding Cautions with other medicines Common questions.
About warfarin Warfarin is a type of medicine known as an anticoagulant, or blood thinner. Warfarin is used to treat people who have had a previous blood clot, such as: a blood clot in the leg deep vein thrombosis, or DVT a blood clot in the lungs pulmonary embolism It's also used to prevent blood clots if you're at high risk of having them in the future. This includes people with: an abnormal heartbeat atrial fibrillation a replacement or mechanical heart valve a blood clotting disorder, such as thrombophilia a higher chance of having a blood clot after an operation Warfarin is only available on prescription.
NHS coronavirus advice When taking warfarin, you need to have regular blood tests. Updated: 15 October Fewer people had intracranial bleeding on the direct acting oral anticoagulants apixaban, dabigatran and rivaroxaban than warfarin. However, the death rate was higher for people taking low dose apixaban and rivaroxaban compared with warfarin, emphasising the need to base decisions on multiple sources of evidence.
The study was observational and based on routinely collected data from general practice registries, so the selection of patients and unmeasured factors may have biased the results. However, the study is large and provides some reassurance about the use of direct-acting oral anticoagulants as an alternative to warfarin. Anticoagulants are used to prevent and to treat blood clots. These may start in the veins and may be carried in the bloodstream to end up in the lungs, or they may start in the heart and be carried to the brain causing a stroke.
People who have hip or knee replacement surgery or who develop atrial fibrillation are at high risk of clots and are usually given anticoagulants. Trials have established that direct-acting oral anticoagulants DOACs are as effective as warfarin but safety information on bleeding risk collected outside the research setting is lacking. This study aimed to compare the safety of DOACs compared with warfarin for people with and without atrial fibrillation. This heart rhythm disturbance affects around one million people in the UK.
This cohort study analysed UK primary care data in two databases with , people prescribed warfarin or DOACs between and It linked patient-level data to the hospital records to see if complications had been recorded here. Researchers followed patients on warfarin for on average six to 11 months and on DOACs for three to nine months. Rates from the larger database, QResearch, are reported in this summary. Both informed risk estimates. The analysis took account of confounding factors such as other illnesses and medications.
This was a large representative study and should reflect real-world use, but it did not look at patient adherence to the prescribed medications. Rivaroxaban, apixaban or dabigatran are recommended in the NICE guideline for the prevention of clots for people having an elective hip or knee replacement.
NICE guidelines recommend either a vitamin K antagonist such as warfarin, or apixaban, rivaroxaban or dabigatran as options for the prevention of stroke and clots in people with non-valvular atrial fibrillation at higher risk. For ongoing treatment, and prevention of recurrence, of DVT and pulmonary embolism the NICE guideline recommended warfarin, but also suggested considering dabigatran, apixaban and rivaroxaban.
This study provides further safety data which will aid shared-decision making on the use of DOACs as an alternative to warfarin.
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