06.03 Coumarins

Overview

      I.         Overview

A.    Derivative of the natural plant anticoagulant known as coumarin

B.    Most commonly prescribed oral (PO)

C.     Requires careful monitoring

1.     Prothrombin time/international normalized ratio (PT/INR)
a. INR
1. 2.0-3.0 while taking blood thinners
b. PT
1. 11-13.5 seconds

     II.         Mechanism of Action

A.    Inhibits vitamin K–dependent clotting factors II, VII, IX, and X

   III.         Indications

A.    Atrial fibrillation

B.    DVT / PE thrombo-prevention

C.     DVT / PE treatment

D.    Stroke prevention

E.     Prosthetic heart valve

F.     Post-MI prevention / treatment

G.    Unstable angina

   IV.         Contraindications

A.    Recent trauma

B.    Active internal bleeding

C.     Bleeding disorders

D.    Intracranial hemorrhage

E.     Severe HTN

F.     Bacterial endocarditis

G.    Liver failure

H.    Kidney failure

    V.         Interactions

A.    Alcohol

B.    NSAIDs

C.     Diuretics

D.    SSRIs

E.     Vitamins

F.     Antibiotics

G.    Foods

1.     Kale

2.     Spinach

3.     Turnip

4.     Mustard greens

5.     Broccoli

6.     Brussel sprouts

7.     Cabbage

H.    Herbals

1.     Green tea

2.     Ginkgo

3.     Feverfew

4.     Garlic

5.     Cranberry

6.     Chamomile

7.     Ginger

   VI.         Side Effects

1.     Bleeding

2.     Red or brown urine

3.     Black or bloody stool

4.     Severe headache or stomach pain

5.     Joint pain, discomfort or swelling (after injury)

6.     Hemoptysis

7.     Hematemesis

8.     Bruising