What it's really like to take Warfarin

8 December 2019

I've been taking Warfarin for nearly six months which, I think is decent enough amount of time to be able to bang on about is as though I know what I'm on about. Warfarin is seen as a pretty serious drug, taken and monitored incorrectly and the results can be fatal - cuts and bumps have to be taken a lot more seriously and in many ways it has a huge affect on the way a person lives their life but, it's also really not as bad as people assume. 

What is Warfarin?

Commonly known as a 'Blood Thinner' warfarin is an anticoagulant - the biggest misconception with warfarin is that it thins blood, it doesn't. Warfarin works to slow down coagulation which is the rate in which blood clots, essentially it makes my blood less sticky which prevents clots from getting stuck in my body and causing a stroke or heart attack etc. The rate in which blood clots is measured by an INR (international normalised ratio) which is a number and best explained by describing the number as seconds; a normal person's INR is 0.9-1, that would mean that a normal person's blood would take 0.9-1 second to clot. Warfarin users have a target INR to reach based on their condition and needs, my target INR is 2.5 so my blood takes 2.5 seconds to clot - this is best demonstrated if I get a small paper cut or cut my lip; it really does take a lot longer to stop bleeding and scab over and often the scab is quite weak and thin and doesn't do as good of a job as someone with a normal INR. People with higher INR's often bruise more than Natasha Beddingfield, this, combined with being incredibly clumsy means that my legs are often covered in bruises but I'd say they're better than a stroke. 

How is Warfarin taken?

Warfarin comes in small tablets of different sizes and colours - the colours determine the amount of warfarin in the tablet. A blue tablet is 5mgs of warfarin pink is 3mgs is and brown is 1mg. Everyone is different so the dose that someone else may need to reach the same INR as me can massively vary for example, I take 9mgs of Warfarin on a Monday followed by 8mgs for the rest of the week, I know someone with the same INR target who only needs 3mgs daily. One of the reasons why warfarin is used to commonly to 'thin blood' is because the dosage and INR levels can be manipulated so easily and this is why INR levels need to me be monitored quite closely to ensure that levels stay on target. 

How are INR levels monitored?

By a small prick of the thumb or finger and a blob of blood being measured in a machine - the machine gives out the level reading and the nurse adjusts the dose accordingly. All Warfarin users in the UK have a yellow book that logs all the INR readings over time and the current dose. This book is also logged on your medical record so that specialists can identify any patterns and trends in levels. Warfarin users are also supposed to carry a medical card at all times so that in the case of an emergency people can be aware that you're more likely to bleed or be bleeding internally etc. 

What affects INR levels?

it's also a misconception that taking Warfarin means a person has to closely monitor what they eat. Vitamins especially K which can cause blood to clot and C that can cause the opposite can have an effect on INR levels but only if eaten in massive amounts. The key is consistency and not massively changing your diet or taking supplements without checking your INR first and afterwards. Alcohol can be consumed in reasonable amounts - I can still get merry and end enjoy a few drinks without concern and if I ever to feel as though I've overdone it I can pop to the Warfarin clinic and get my levels checked (I've never had to this because despite being an idiot I'm quite responsible).

However, being a young-ish woman and having a toddler does come with it's struggles when it comes to taking Warfarin. Hormones have a huge impact on INR levels and menstruation always drops it to a 2 or 1.7 and picking up Fred's two-monthly stomach bugs have increased it to around 3-5 but knowing the causes for peaks and drops means that myself and the specialists can identify a pattern and not have cause for concern; an INR higher than 9 is a cause for immediate and concern and treatment anything below 6 is reason to be careful and stay away from sharp objects. 

How is a high or low INR treated?

A high INR is treated with vitamin K - usually an injection in hospital, a lower INR would just be an increase in Warfarin dosage. 

Periods and Warfarin?

Warfarin periods are worse than regular periods, it feels as though there is more is blood but essentially it is just that the blood is 'thinner' or less clotted than it would be without Warfarin. It also looks more like fresh blood and bright red which can sometimes be alarming, thankfully my periods haven't been too badly affected and last for 4-5 before stopping - there was one instance when I had a period at the same time as a stomach blood and I bled for 10 days but this was also due to my high INR of 5. When my INR when back down the bleeding stopped. 

Warfarin side effects

Aside from the obvious bruising and bleeding I've also developed very dry skin since taking Warfarin, it's nothing that can't be managed with some decent moisturiser but can also be annoying when it comes to my lips and eyes. I've also got a very dry mouth, especially on the side affected by the stroke - this can be frustrating as water doesn't sooth it and I can sometimes feel as though I'm choking or develop mouth ulcers. The only side effect that gets me dows is my hair thinning, since taking Warfarin my hair has taken a hit and is very dry and brittle and much thinner than it was again, there's not much I can do about this and it's still better than a stroke. 

When Warfarin is a ball ache 

  • Warfarin and pregnancy are not mates so if by some miracle I was to meet someone and want another baby to ruin my body I would have to let my consultants know and switch to Heparin injections as Heparin wouldn't reach the baby's bloodstream 
  • Warfarin has to be taken at the same time every day (6pm) in case the dose changes at a clinic appointment and can be amended immediately 
  • When I need a dentist appt. I have to let them know in case they want my INR changing to avoid as much bleeding 
  • Missing doses can be fatal, it takes three days for Warfarin to leave the body and without it it is very likely that I would have another stroke or instance of thrombosis. 

Is Warfarin as bad as people think?

No, ultimately being on a medication that's preventing me from popping my clogs is ideal, the side effects can be frustrating but it doesn't have a huge impact on my life at all. It's frightening to be told that I need to be on a medication that is seen as so serious and somewhat dangerous for the rest of my life but it's really easy to manage and once a person's levels are consistently in range the amount of clinic appointments needed are lowered - I currently get seen every four weeks, when I'm fully in range I'll go to six weeks and then twelve. At some point I'll invest in an INR reader so that I can monitor my levels from home and adjust my dose accordingly but they are expensive. 

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