When you’re on anticoagulants, you may have concerns that you’re not quite sure if you should be bothering your doctor with.
My patients often bring up these concerns towards the end of a visit often prefacing them with “Am I being silly doctor?” I feel that although my work as a haematologist can be very busy, answering a patient’s questions is a core part of my job, so I’d rather patients tell me their concerns rather than silently worrying because they don’t want to bother me. Having said that some concerns are more dangerous than others, so this is the final in a series of 3 posts over 3 Mondays on concerns that are;
- Life-threatening
- Valid
- Niggling
Today’s concerns are those that many people have but usually have no impact on their health.
1. I get bleeding when I brush my teeth
Gum bleeding on anticoagulants is very common. The bleeding comes from the fragile gums related to gum disease (gingivitis). You can reduce the risk of bleeding by maintaining a high level of dental hygiene, floss regularly or use one of those air flossers. We also recommend regular dental follow-up. If you have a lot of trouble make sure you use a soft-tooth brush and a regular antiseptic mouthwash can help to reduce the risk of infections and prevent gingivitis. If it is a major problem talk to your dentist.
2. Is it OK that I missed one warfarin pill?
Missing the occasional warfarin tablet is not a major problem. Warfarin has a prolonged effect on the way your blood clots. Missing one day will lead to a slight fall in the INR but you need to be off treatment for 4 to 5 days before your clotting will get back to normal. If you forget a dose but remember the same day, we recommend you take the dose as soon as you remember, but if you don’t remember until the next day, you should just miss that dose. Don’t take two doses on the same day.
3. I drank 3 pints of beer last night, will that muck up my INR?
The simple answer is yes. Alcohol will affect the INR, but it has surprisingly little effect if you don’t drink too much. One or two drinks is fine and you will have no problem at all if you have a similar amount of alcohol everyday, like one glass of wine with dinner. The worst thing you can do is have an alcohol binge and drink a lot of alcohol on one day. This does two thing; it alters the warfarin absorption and inflames the stomach making you more likely to bleed. One time some people do notice a change in their INR if they go on holiday and drink much more than usual. Just be aware that alcohol can cause problems with warfarin control.
4. I had a serving of green vegetables before my INR test -Will that affect it?
Questions about diet are some of the commonest questions I get relating to warfarin treatment. Most people are aware that vitamin K can alter the INR and that green vegetables contain a lot of this vitamin. However, the vitamin K in vegetables is poorly absorbed and you need to take a lot of vegetables to significantly change the INR. One study showed that people on warfarin needed to eat over half a kilogram of brocolli daily to have a significant impact. My advice is to keep to a normal diet and that normal portions of green vegetables are safe. Brocolli and spinach are the vegetables that contain most vitamin K so don’t binge on these! There are well reported cases of people having problems if they eat too much of one vegetable. There was the case of a man who loved Brussel Sprouts and ate excessive amounts at Christmas time and had problems controlling his INR.
5. I’m travelling to a different time zone, when should I take my tablets?
There isn’t a correct answer for this, but most people advise that you take your medication at the same time you would if you were at home. So if you usually take it at 6pm at home then take it at 6pm in the new time zone. At most there will be a 12 hour difference and this should not affect the INR.
Have you ever had any of these concerns? Are there any other concerns you have which you’d like us to cover in a future post?
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