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Coumadin Drug Center

Coumadin (warfarin) is a blood anticoagulant that inhibits the function of Vitamin K dependent coagulation. Coumadin is available as a generic, termed warfarin or warfarin sodium. Coumadin is used to inhibit the coagulation of blood to reduce or prevent the chance of developing heart attacks (myocardial infarctions), strokes, and venous and other blood clots (deep venous thromboses, pulmonary embolisms and thrombi produced with atrial fibrillation). Coumadin is also used to treat these conditions if they develop. The most common side effects of this drug are easy bruising and bleeding.

Coumadin has a wide range of tablets: 2, 2.5, 3, 4, 5, 6, 7.5 and 10 mg tablets are available. An injectable form of the drug (5 mg) is also available. The dose of Coumadin is determined in each individual by administering a trial dose and ten measuring the patient's INR (International Normalized Ratio), a lab test that is standardized by the WHO (world Health Organization) and recognized worldwide. Therapeutic ranges for this test are between 2.0 to 3.0 when a patient is taking Coumadin. INR levels below 2 may allow easier blood clotting to occur while levels above 3 may cause excessive tendency for the patient to bleed. Several different Coumadin doses and INR tests (over 1-4 weeks) are usually necessary to establish a relatively stable and therapeutic INR level in each individual. Unfortunately, there are at least 60 different drugs that may increase or decrease the body's ability to utilize Coumadin any the majority of people that need Coumadin are often require one or more of these drugs; this situation also is why each Coumadin dose is individualized. The major risk factor with Coumadin is hemorrhage. Small emboli may occasionally be released while on Coumadin, causing "purple toes;" although this may be reversible, a few patients may develop gangrene. Pregnant women should not be given Coumadin; lactating women may need to be closely monitored and their breastfed infants should have their INR checked, according to some investigators. Although Coumadin has been used in pediatric patients to prevent clot formations, children under 18 have not been well studied with this drug and some investigators suggest achieving stable INR levels seems more difficult in the pediatric population.

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