Dangers of warfarin

Take care with Warfarin. Warfarin is an oral anticoagulant - in other words Warfarin is a drug taken by mouth used to prevent blood clotting. It used to be known as a rat poison - give rats a lot of Warfarin and they suffer death from internal bleeding.

So did Donald Dewar, the most senior government figure in Scotland and member of the Labour Cabinet, who die on 11 October 2000, mourned across Briatin. He suffered a fatal brain haemorrhage following a fall, after recent surgery to replace an aortic heart valve. The Warfarin successfully prevented clots on the valve, but the Warfarin also thinned his blood, probably made the bleed worse and made it even more difficult for surgeons to operate.

Warfarin works by blocking the creation of Vitamin K - vital to normal blood clot formation. Warfarin is usually very safe when used carefully but the level in the blood is critical. Too much Warfarin and you can bleed to death - as simple as that. Too little Warfarin and you could have, for example, a lifethreatening clot such as a deep vein thrombosis resulting in a pulmonary embolus (clot passing from leg to lung).

The trouble is that Warfarin levels are affected by a huge number of other drugs that people may be taking at the same time. These other drugs affect Warfarin levels by slowing or speeding up the rate of Warfarin destruction by the liver, or by releasing more free Warfarin into the blood (usually quite a lot of Warfarin is bound to proteins in the plasma), or by blocking absorption of Vitamin K, or by blocking Vitamin K production by bacteria in the gut. Here are some examples of how Warfarin dose may need to be adjusted:

Warfarin effect is increased by:

bullet Phenylbutazone bullet Alcohol bullet Anabolic steroids bullet Chloramphenicol

bullet Sulphonamides bullet Colchicine bullet Reserpine bullet Mefanamic acid bullet Aspirin bullet Phenytoin bullet Broad spectrum antibiotics bullet Erythromycin bullet Liquid paraffin bullet Clofibrate

Warfarin effect is reduced by

bullet Barbiturates bullet Rifampicin bullet Oral contraceptives bullet Glutethimide bullet Griseofulvin

Weight changes and changes in kidney function can also affect Warfarin levels.

A common problem can be if a person is stable for a long time on Warfarin with a combination of other drugs - but then one or two of the other drugs are stopped, perhaps sending Warfarin levels sky high or perhaps far too low.

A common early sign of Warfarin overdose is spontaneous bruising - patches of skin discolouration without a history of injury, or even blood in the urine. The treatment of too much Warfarin is an injection of Vitamin K which usually begins to act within 4 hours.

Blood-thinning drug warfarin may raise risk of death from brain haemorrhage People who regularly take the blood-thinning drug warfarin may be doing themselves more harm than good because it can increase the risk of death from a brain haemorrhage.

A new study has discovered that the drug, which is taken by hundreds of thousands of patients at risk from a blood clot, may increase bleeding and so the risk of death during a haemorrhage in the brain.

The research carried out in the United States found that those taking the drug had twice as much bleeding when they did suffer a stroke. This in turn led to a greater risk of death unless treated quickly.

Warfarin, for which there were 6.6 million prescriptions issued by the NHS in 2006, is taken by people at serious risk from an eschemic stroke caused by a blood clot in the brain which blocks a blood vessel and starves the brain of oxygen.

It is also effective in combating an abnormal heart rhythm called atrial fibrillation.

But the new research from the University of Cincinnati and published in the American academy of Neurology journal shows that its blood-thinning properties can actually increase the danger from a different sort of haemorrhagic stroke where a blood vessel bursts.

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Scientists led by Dr Matthew Flaherty used brain scans and found that if the drug makes the blood too thin, it can increase the risk of brain haemorrhage, a type of stroke caused by bleeding in the brain.

"Warfarin is very effective for preventing ischemic strokes among people with atrial fibrillation and for most patients with this condition it is the right choice," said Dr Flaherty.

"However, people who have bleeding into the brain while taking warfarin are at greater risk of dying than other people with haemorrhagic stroke.

"This shows the importance of good monitoring and adjustment of warfarin dose. People should talk to their doctors about the proper management of warfarin and learn the signs of stroke so they can get to an emergency room immediately if a stroke occurs."

The study involved 258 people who had brain haemorrhage, 51 of whom were taking warfarin. Participants were 69 years old on average and lived in or near Cincinnati.

The group underwent brain scans to confirm the type of stroke. The brain scans were used to measure the size of the blood clots.

The study found that people who took warfarin and suffered a brain hemorrhage had about twice as much initial bleeding as those not taking warfarin.