Can we talk?

Coumadin, the wonder drug

    Coumadin is a wonder drug. It saves many lives. The IV version is Heparin, but it can only be used in a hospital setting. It's the best because of the steady delivery by the IV. Generic coumadin is called Warfarin.

    So what do these wonder drugs do? They thin the blood to avoid clotting in patients at high risk. Neither can be administered without regular blood testing. In the hospital, the IV patient will be tested several times a day, increasing the safety level by allowing dosage adjustment or temporary cessation. With the pill, testing is done every 2 to 4 weeks, with a finger stick these days. Frequency of testing is determined by the stability of the test results.

      Who needs blood thinner? Someone who just had a pacemaker installed, or heart valves replaced, and people with certain surgeries for a recovery period to reduce risk of clotting.
   
      The pill Coumadin, or warfarin, is available from 1 mg to 10 mg. The doctor or pharmacist, depending on your area's system, will recommend a daily dosage, and make changes as necessary from test results. It may prevent a heart attack or stroke. When administered properly, this miracle drug saves lives.

    The dangers lie in not taking enough, or taking too much. If your blood is not thinner than normal, you risk a clot that will hit your heart or your brain. If it is too thin, you risk internal bleeding or a cut that can't stop bleeding. At least you can see the external bleeding, and pressure can be applied. The internal bleeding can result from a fall, a sudden stop of a car slamming your head back against the seat, or a shove, or shaking. The internal bleeding can be as bad as a clot, but the signs are not immediately visible.

    Then we have spontaneous bruising. Big or little blue or black marks that just appear with no pain or remembrance of bumping. Usually they accompany too thin test results, but not always.

    Not only must the patient keep his medicine straight, but the testing, too. Refilling the correct size can be a problem, such as refilling a 4 mg tablet, when the doctor had written one for 3 mg. So many dangers compound. It takes vigilance to keep it straight, especially when other drugs may be administered for other problems. This isn't just a problem for the elderly, but it gets worse for those whose eyesight is failing, memories are confused, or hands are arthritic. 

    This isn't a job for government workers. Caring and nurturing relatives, friends, or employees should be the helpers for those who can't manage this miracle, but risky drug.