Counselling

ASPIRE: THE QUEST FOR EXCELLENCE

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DR. ANKUR GARG

DR. NIKHILESH RAO

3rd Floor, New London College, Sceptre House, 75-81 Staines Road,
Hounslow, London, TW3 3HW
 Notes

3rd Floor, New London College, Sceptre House, 75-81 Staines Road,
Hounslow, London, TW3 3HW
Discharge Summary

Presenting Complaint: Patient presented after having fit. Had aura before fit. Fit lasted for 3
minutes. Patient has urinary incontinence and confusion. Had 2 episodes of fit in the last 4
weeks.

Investigations: Blood Test - Normal, EEG - Abnormal

Diagnosis: Tonic Clonic Grand Mal Idiopathic Epilepsy

Treatment: Sodium Valproate 300 mg BD

Please see the GP regularly.

 WARFARIN
ANTICOAGULANT
RECORD

Provided as a service to medicine by

Concordia International Rx UK Ltd
HOSPITAL/GP PRACTICE: ..................................................................... Discharge Warfarin Dose (last 5 days): ...........................................
Telephone: ....................................................................................................... Clinician managing
anticoagulation: ...........................................................................................
ANTICOAGULANT CLINIC
Family Doctor: ...............................................................................................
Telephone: .......................................................................................................
Doctor’s Address: .........................................................................................
Name: ........................................................................................................ ..................................................................................................................................
Address: ...................................................................................................
..................................................................................................................................
........................................................................................................................
Telephone: .......................................................................................................
Telephone: .................................. Mobile: ........................................
Other Contacts: ..................................................................................
Day and Times of Clinic.
Date of Birth: .........................................................................................
Monday: ............................................................................................................
Hospital No.: ..........................................................................................
Tuesday: ............................................................................................................
Next of Kin: ............................. Telephone: ....................................
Wednesday: ....................................................................................................
Brand of medication: ................................................................................. Thursday: ..........................................................................................................
Referring Consultant: ................................................................................ Friday: .................................................................................................................
Reason for Warfarin: ...................................................................................
Expected duration
of Warfarin treatment: ..............................................................................
Target INR range: .........................................................................................
Date of starting Warfarin: ........................................................................
If you change your brand of Warfarin
please inform your GP/Warfarin clinic immediately

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 KEEP YOUR TABLETS IN A SAFE PLACE What is Anticoagulant treatment?
WELL OUT OF THE REACH OF CHILDREN
Anti means “against” and coagulant refers to “blood clotting”.
An anticoagulant medicine prevents harmful clots from
This booklet has been given to you because you have
forming in your blood vessels by making your blood take
started a new medicine known as an anticoagulant.
longer to clot. This is sometimes referred to as “thinning”
A healthcare professional may go through this booklet your blood. It is also used to stop existing clots from getting
with you, explain what it all means and answer any bigger and to stop parts of a clot breaking off and travelling
questions you may have. to other parts of the body.
The anticoagulant you have been prescribed is
called warfarin.

Why do I need Warfarin?

Your Doctor will have prescribed Warfarin for you if you
are at risk of developing a harmful clot or if you have an
existing clot.
Here is a list of some of those conditions:
• Atrial Fibrillation (Afib/AF) – irregular heart beat
• Biological or Mechanical Heart Valve (AVR or MVR)
• Deep Vein Thrombosis (DVT) – clot in the leg or arm
• Pulmonary Embolism (PE) – clot in the lung
• Myocardial Infarction (MI) – heart attack
• Ischaemic Heart Disease (IHD or CAD)
• Cerebrovascular Accident (CVA) – stroke
Warfarin is sometimes used for reasons other than
those listed. Talk to your Doctor if you are not sure of
your diagnosis.

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How do I take Warfarin? How will I be monitored while on
Take Warfarin once a day in the evening, at about the same
Warfarin treatment?
time each day, preferably on an empty stomach washed You must have a regular blood test called an INR test.
down with a full glass of water. The INR test stands for International Normalized Ratio.
This test can be done either at the Warfarin Clinic or the
Warfarin tablets are colour coded to help you take the
GP surgery.
correct dose. They are available in 0.5mg (white), 1mg (light
brown), 3mg (blue), and 5mg (pink). It is very important that The dose of Warfarin that you will need to take will
you know exactly what dose you are taking in milligrams depend on your INR test result. If your INR result is
(mg) and not just the colour. If you are unsure about the out of range appropriate for your condition, your dose
colour and strength of your tablets please ask the staff at of Warfarin will need to be increased or decreased
the Warfarin Clinic/GP. accordingly. The Warfarin dose required to achieve the
target INR varies for each person. Any changes that are
0.5mg = 1mg = 3mg = 5mg =
made to your Warfarin dose will be explained to you at
the Warfarin Clinic/GP. If you do not understand your
What do I do if I forget to take a dose? new dose please ask staff at the Warfarin Clinic/GP to
If you miss a dose and remember before midnight, you can explain it again.
still take that dose.
If you forget your dose for a longer time, do not take that
dose to catch up, but take your next dose when it is due.
Remember to tell your doctor when you see him/her next
and have your blood checked.
If you miss more than one dose, ask your doctor for advice.

What do I do if I take too many Warfarin?

If you have taken too many Warfarin tablets by accident
it’s important that you contact the Warfarin Clinic/GP
immediately and have your blood checked.

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Are there side effects? What happens if I need to go to the dentist?
You will bruise easily while you are on Warfarin and bleeding You can still go to the dentist as usual but it is important
will take longer to stop but it should stop when pressure that you tell your dentist that you are taking Warfarin. In the
is applied. It is important that when you have your blood majority of cases your dental treatment can go ahead as
tested that you keep your finger on the band aid for a normal without stopping or adjusting your Warfarin.
few minutes after having your blood taken to ensure it
However your dentist will need to see a recent INR result
stops bleeding.
to ensure it is safe to provide treatment. Get in touch with
The most serious side effect of Warfarin is heavy or the Warfarin Clinic/GP at least one week before a dental
prolonged bleeding although fortunately this is rare. extraction so that an INR test can be performed and your
dose adjusted if necessary. Always tell the dentist if you
If you experience any of the following, seek medical
have had a heart valve operation as you may need to
attention and have an urgent INR test:
have antibiotics before your dental procedure.
• Prolonged nose bleeds (more than 10 minutes)
• Blood in vomit
Can I take other medications with Warfarin?
• Blood in sputum Some medications can interact with Warfarin. If, during your
course of Warfarin, you are starting or stopping another
• Blood in stool (red or black faeces)
medication, the prescriber may advise that you should have
• Blood in urine (red or dark brown urine) a blood test within five to seven days of starting the new
• Severe or unexplained bruising medication (e.g. Analgesia). If you start an antibiotic it
• Severe bleeding gums is advisable to have a blood test within three to five
• Unusual headaches days of starting the antibiotic. Please tell the staff at
the Warfarin Clinic/GP if you start or stop any new
• Women who experience heavy or increased bleeding
medications, including antibiotics.
during their menstrual period or any other heavy vaginal
bleeding. Avoid all aspirin based medications and non steroidal anti-
inflammatory medications unless prescribed by your doctor
If you cut yourself, apply firm pressure to the site for at
and please tell whoever is monitoring your Warfarin if you
least 5-10 mins using a clean, dry dressing. If the bleeding
are taking these. Paracetamol may be taken with Warfarin
persists seek medical attention.
for pain, if necessary, but prolonged use can affect your INR.

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Please note that some Paracetamol products can contain Potential Interactions
aspirin. ALWAYS tell your pharmacist that you are on Warfarin.
Green tea, soya and soya protein products should only be
Please contact your Warfarin Clinic/GP as soon as you have eaten in moderate, consistent amounts and try to stick to
been discharged from hospital. the same brand of these products.
If you intend to take herbal remedies or supplements (e.g. Taking probiotics could in theory increase the production
multivitamins, cod liver oil, omega 3 including herbal teas) of Vitamin K in your diet and reduce your INR levels. If you
discuss with the staff at the Warfarin Clinic/GP/Pharmacist would like to take probiotics stick to the same quantity and
before you start as these can potentially interact with Warfarin. brand daily and let the staff at the Warfarin Clinic/GP know
Are there any dietary restrictions? if you start or stop these.
Avoid grapefruit juice, cranberry juice, mango juice,
For your good health it is important that you try to be
mangoes and seville oranges as they have been linked to
consistent with what you eat and drink while you are on
high INR results.
warfarin, particularly foods that are high in vitamin K. If you
have too much vitamin K in your diet you may see your INR Can I drink alcohol?
levels go low and your warfarin requirements increase. The
following is a list of vitamin K rich foods. You do not need Alcohol may make your INR go very high, this can lead
to avoid these foods as they are very nutritious but aim to bleeding problems. Before consuming alcohol please
for consistency in your intake of these foods. consult with your GP who can advise you on what is a safe
and moderate amount to consume.
Very high Vitamin K containing foods
Broccoli, Cabbage, Curley Kale, Brussel Sprouts, Collard Greens, It is dangerous to binge drink while you
Endive, Dark Green Lettuce, Nettle Leaves, Spinach, Soyabean Oil, are on Warfarin.
Scallions, Spring Onions, Parsley, Seaweed and Turnip Greens. If you give up alcohol completely for a period of time
High Vitamin K containing foods please tell the Warfarin Clinic/GP as they may need to
Asparagus, Liver, Red Leaf Lettuce, Watercress, Canola Oil, readjust your Warfarin.
Rapeseed Oil, Salad Dressing.
If you enjoy eating the foods listed above it is easier to
regulate your warfarin if you have the same quantity daily.
If you suddenly increase or decrease your intake of these
foods please let the staff at the Warfarin Clinic/GP know.
8 9
Pregnancy and Breastfeeding: What should I do if my Warfarin is stopped?
If you are pregnant or think you may be pregnant If your Warfarin is stopped by your Consultant please tell
before taking Warfarin, you should tell your doctor. Oral the Warfarin Clinic/GP. You should never stop your Warfarin
anticoagulants in pregnancy carry a potential risk of without firstly discussing it with your Consultant/GP/
damaging the unborn child. If you find that your period Warfarin Clinic.
is over due, and you think you may be pregnant, you
must discuss it with the staff at the Warfarin Clinic/GP Remember always:
straight away. Keep your appointments for your blood to be checked. If
you cannot attend, phone the Warfarin Clinic/GP and make
Can I travel while on Warfarin? another appointment.
If you have had a clot in your leg or your arm please discuss
Tell the Warfarin Clinic/GP if you are going for any medical/
travelling with the Warfarin Clinic/GP. It is advisable to check
surgical procedure as you may need to stop your Warfarin
your INR before going overseas so you can be sure of the
beforehand.
correct dose whilst away from home. You may also need to
have your INR checked while you are abroad, depending on Make an appointment to have your blood checked if you
the length of time you intend to be away. have recently been in hospital because your tablets may
have been altered or you may have been put on new
Remember to take enough Warfarin with you while you
medication. It is advisable to have it checked within a
are away. It is advisable to take 2 packs, one in your hand
week of getting home.
luggage and one in your main luggage. Always remember
to take your yellow book with you. Do not binge drink on Show this book to your GP, Consultant, Dentist,
holidays and try to maintain your usual diet. Pharmacist, Nurse or other Healthcare Professionals such
as a Chiropodist, Physiotherapist before you receive any
Can I play sports while taking Warfarin? treatment or medicine.
Your Doctor may want you to avoid any activity or sport that Make sure that you have enough Warfarin tablets so you
may result in a serious fall or injury such as contact sports. do not run out of them. Always have at least a week’s supply
Discuss this with the Warfarin Clinic/GP. of tablets.

“If in doubt check it out”

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 Your personal INR
& Warfarin Records

12 13
0.5mg = 1mg = 3mg = 5mg =

Strength Of Tablets (in mgs) to be taken each day Total

Blood Test
weekly Date of Authorized
DATE Result
dosage Next Visit by
(INR) Mon. Tues. Weds. Thurs. Fri. Sat. Sun. (mgs)

14 15
Other Medications Other Medications

Name Strength Frequency Name Strength Frequency

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Provided as a service to medicine by
Concordia International Rx UK Ltd
CON/WAR/NP/0001
December 2017