COUMACARE PROGRAM

WHAT IS COUMACARE? It is actually the name of a computerized software program that we use to record protime results and follow or track patients on anticoagulant therapy. We started this program in February, 1998 to help manage a growing group of patients in our practice on Coumadin. We have over 400 patients enrolled in this program and feel that it has been very successful in helping us take better care of patients. We even follow patients in nursing homes and when they leave the hospital.

HOW DOES COUMACARE WORK? If you are a patient on Coumadin either long-term or short-term, when your protime is drawn the results are recorded in the data base of the tracking program and printed out for designated personnel to deal with on a daily basis. You health care provider does not see the results each time the test is drawn unless there are some questions or concerns about the results, your medication program, or any side effects you may be having while on the medicine. We will try to call you with your results on the day the blood is drawn to give you the results and tell you about how you should take your medicine.

WHO WILL CALL ABOUT MY TEST RESULTS? A nurse practitioner or physician will review your lab results and previous dosing schedule for Coumadin. A decision will be made based on your current blood test as to how much coumadin you should take and when the next blood test should be done. A medical assistant or nurse will call you with your results and directions. If you don=t come in for your next blood test on time, we will call to remind you to come in for your blood draw. .

WHY DO I HAVE TO HAVE BLOOD DRAWN SO OFTEN AND WHY DOES MY DOSE FREQUENTLY CHANGE? Coumadin is a blood thinner and can be affected by other medications-- prescriptions or over-the-counter. It can be affected by things that one eats or drinks, or by changes in bowel habits (mainly diarrhea). Therefore, we need to monitor drug levels carefully and even small adjustments in the dose or forgetting to take any of your medicines can change the drug level and put one at risk for bleeding or clotting. We try to be sensitive to the pain and inconvenience of having blood drawn frequently as well as the confusing dose changes when we make decisions about your blood test results.

HOW DO I GET MY BLOOD DRAWN OR GET TEST RESULTS? Schedule your blood draws (659-4468) and come to the Milwaukie or Talbert Center office at the scheduled time for your blood test. If you come after 2PM we cannot guarantee that the results will be available to you that day. YOU CAN REACH US AT 353-1281 AND YOU CAN LEAVE A VOICE-MAIL MESSAGE AT THIS NUMBER.

Helpful Precautions and Advice for Patients Taking Anticoagulants

Don’t mix other medication with warfarin
The chief precaution with this drug revolves around interactions with other drugs. Some medications magnify the effect of warfarin (Coumadin) and others may act as an antidote or inhibit its effect. Many over the counter medications or remedies interfere with warfarin control. It is important to let the Coumacare program know when you stop or start any medicines so we can make a decision about how this might affect your level of anticoagulation. Aspirin is the most common drug that affects warfarin regulation. Alcohol, antacids, antihistamines, antibiotics, pain medication, and even herbal remedies can have a dramatic effect on warfarin. A list of medication known to interfere with warfarin can be found at the end of this article although the list is not all inclusive.

Follow a schedule
Take your medication the same time every day. It is easier for us to adjust your dose if you take your warfarin in the evening. If we call you with abnormally high blood test results and you have already taken your dose, it is hard to "hold" that day’s dose of medicine and may actually require some emergency measures be taken. Thus the evening dosing of warfarin allows for easier adjustment of your warfarin dose.

Check your pills
It is possible to get confused about your warfarin pills and their strength. The tablets are color-coded and have the milligram strength imprinted on the tablet but always double check your pills when you get a new prescription filled. DO NOT follow label directions with warfarin because this dosage is adjusted according to blood test results and only rare individuals take the same dose of warfarin month after month. Whenever possible, we only want patients to have one strength of warfarin tablets to make correct dosing more accurate and less confusing for you.

Plan ahead
If you are running short, call for a refill before you run out. Even one day without your medication can affect your blood test results. If you are planning to travel, contact us so we can make arrangements to check your protime before you leave on your trip. If necessary, we may have to make arrangements to check your protime while you are traveling.

Dental checkups
Let your dentist know you are taking warfarin. There are some new ideas about whether you should stop taking warfarin prior to dental procedures or dental surgery. At one time it was felt you had to be off your medicine before such procedures. However, now there is research that shows the risk may be greater if you stop your medicine and any bleeding complications are more of a minor nuisance rather than a major medical/surgical problem. This decision needs to be individually determined by the dentist and your Medical Provider.

Special Precautions
Avoid traumatic sports if possible. Wear protective gear for activities like bicycle or horseback riding. Use a soft toothbrush to prevent gum injury. Use an electric razor rather than a straight or blade razor. Wear gloves while gardening.

Pregnancy
Warfarin is contraindicated in pregnancy. If pregnancy is a consideration, consult your physician as soon as possible and preferably before pregnancy occurs!

What to look for
The following symptoms could be signs of excessive warfarin levels in the blood:

Nosebleeds, bleeding gums, red or brown urine, red or black stools, cuts that do not stop bleeding, bruises that enlarge, excessive menstrual flow, headaches, abdominal pain, faintness, dizziness, or unusual weakness.

Medications That May Interfere with Anticoagulants

This list is not meant to be all inclusive.  If you are started on new medication ask your Pharmacist, your health care provider or the Coumacare program if there is the likelihood of an interaction with your warfarin.

back to top

Abbott

Alberts

Becker

Bohme

Brandon

Brown

Buhl

Callaghan

Davis

Devisser

Gallegos, M.

Gallegos, P.

Jacqmotte

Lebert

Maslen

Mayer

McAnulty

McNichol

Mick

Nishikawa

Seetharaman

Silver

Thompson

Verdieck

Wilson

Zhang

Zhang

Business Office

Clackamas Internal Medicine

Milwaukie Family Practice

Northwest Medical Laser

Northwest Therapy

Talbert Center Family Practice

Sellwood/Moreland Family Practice

Appointments

Billing / Patient Accounts

Check In and Parking

Disease Management

Emergency/After Hours Care

Hours & Addresses

Lab & Radiology

Medical Records/Forms

Northwest Therapy

Nursing Services

Referrals

Prescription Refills

Quality Commitment

Services Available

Your Health

Asthma

Child Health

Diabetes

General Health

Men's Health

Nutrition

Seasonal Health

Services & Classes

Women's Health

YOUR HEALTH