[Learning Points]
  1. To prevent the formation of thrombosis in the blood, regular blood testing.
  2. Precautions for medication: Try to avoid trauma and bleeding in daily life, such as: bruising, massaging, cutting vegetables too quickly; choose a soft-bristled toothbrush; men, please use an electric razor to shave. Apply pressure around the site about 10-15 minutes.
 
I.What is this medicine?

To prevent the formation of thrombosis in the blood, regular blood testing  (international normalized prothrombin time ratio, INR) as the basis for adjusting the dose of drugs, preventing and treating thrombosis and reducing the risk of bleeding.

 

II.Usual medicine of anticoagulant in VGHTC:

Name of drug

WARFARIN (1mg/ table)

WARFARIN (5mg/ table)

Appearance

 

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III.What precautions do I need to take while using warfarin?

    1. Precautions for medication:

  • In case of red stool (pitaya with red skin and purple meat) or black stool (iron, pig blood, chicken blood, duck blood, goose blood, sheep blood, cherries, chocolate, raisins) caused by eating food or drugs Waiting for food), please continue to observe the color of the stool.
  • Try to avoid trauma and bleeding in daily life, such as: bruising, massaging, cutting vegetables too quickly; choose a soft-bristled toothbrush; men, please use an electric razor to shave. Apply pressure around the site about 10-15 minutes.
  • Immediate return to hospital for blood test: A. Hematuria, bloody stool, vomiting blood, hemoptysis, eye hemorrhage, more than usual menstrual blood volume and bleeding due to non-external injury (gum bleeding, nosebleed, severe bruising). Physicians will adjust the dose of the drug, Do Not stop the drug by yourself.
    2. Discuss matters with your doctor: 
  • If you forget to take the medicine, make up the daily dose, take the medicine at the original scheduled time and dose the next day, and inform the doctor when you return to the doctor about the time you forgot to take the medicine.
  • Anticoagulants mainly reduce the blood coagulation function. The doctor will decide the medication time according to your condition. If you take it incorrectly, it may cause severe bleeding. Please be sure to follow the dosage prescribed by the doctor. Do Not stop or increase or decrease the dose by yourself.
  • If you need to receive any invasive examination and treatment ( eg : dental treatment , microscopy examination, cardiac catheterization, etc. ) or surgery, the physician must be informed are taking anticoagulant drugs so that they can be properly treated before receiving treatment to reduce bleeding.
  •  Avoid the interaction between traditions Chinese medicine and medicine.
  • Taking anticoagulant during pregnancy may cause fetal malformation please inform your doctor before you plan to be pregnant or breast-feeding. 

IV.What do I need to know about warfarin and my diet?

  1. Prohibition of consumption Natto Capsules and Soy Lecithin Extract Health Food Capsules.
  2. How to avoid the lack of anticoagulants when taking anticoagulants? Diets with high vitamin K content and Chinese medicines and Western medicines can cause insufficient anticoagulants. Please follow the recommendations below:

Type

Name

Notes

Food

Kale , spinach, amaranth, lettuce, celery, cabbage , purple cabbage, kale, string beans, green beans, bean sprouts, cabbage (bud) , shallot, onion, green (white) broccoli, radish, mustard, seaweed, spinach, bok choy, A dish, Sichuan seven, cucumber, bulk food, large white dish , asparagus, leeks, sweet potato leaves, mainland sister, black fungus, raw salad julienne, animal liver.

Daily should quantify the average intake of less rich in vitamin K foods ( daily ingestible about 3 to 5 parts, each dish is about the size of your palm) , avoid excessive intake of foods containing vitamin K so as not to reduce the efficacy.

 Fruit

Avocado, papaya, green kiwi , noni juice .

Take up to one serving a day, each serving approximately the size of your palm .

Healthy food

Coenzyme Q 10 , high-dose vitamin C, nutrients containing vitamin K or vitamins (such as good storage, comprehensive vitamins).

The physician's consent is required .

 Tea

Such as oolong tea, green tea , black tea, etc.

 

 

The physician's consent is required.

Cooking oil and

Spices

Soybean oil, soybean oil, canola oil

Cook with low oil or change olive oil .

         3. How to avoid the overdose of anticoagulant?
  • Poor diet habits, Taking Chinese medicine and Western medicine will lead to anticoagulant overdose or inhibit platelet function by itself, and there is a risk of bleeding when taken together.
  • Please follow the recommendations below: Forbidden to eat: ginseng, western ginseng, ginkgo, ganoderma, angelica Oriental ginseng, Jilin ginseng, red dates, wolfberry, ginger garlic, Hypericum perforatum (hypericum perforatum), Turtle and Deer Gum, Ginger, Pineapple Enzyme and Papaya. Enzyme.

Type

Name

Notes

Food

Mango, cranberry, grapefruit juice or grapefruit, cooked ginger, red yeast rice, grapefruit, Baiyou , mushroom class.

Do not overdose, it is recommended to take about one palm size per day at most.

Healthy food

Fish oil, vitamin E, grapes, Sugar amine.

Requires the consent of a Doctor's

Drug

1. Hypolipidemic drugs :

Lipanthyl, Lopid and statin class ( Crestor, Lipitor, Lescol ) and the like.

 

When drugs are used together, increase the number of blood tests for INR.

2. Analgesic and Anti-inflammatory (such as NSAIDS), antibiotics.

3. Antiarrhythmic drugs : such as Amiodarone.

4. Uric acid lowering drugs : Benzon, Allopurinol et al.

 
V. Summary

Know the signs and symptoms of blood clots, bleeding, and a stroke. Make sure that you know your target INR with blood tests. Make sure you discuss any questions you have with your health care provider.

 

VI. Reference

  1. 臺中榮民總醫院(2026).臺中榮總藥品手冊查詢系統.http://www3.vghtc.gov.tw: 8080/ pharmacyHandbook/
  2. Mandefro, B. T., Sundara, S. V., Lu, X., Busmail, H., Weerakoon, S., Avula, S., & Iftikhar, L. (2025). Effectiveness and Safety of Direct Oral Anticoagulants Versus Warfarin in Patients With Mechanical Heart Valves: A Systematic Review. Cureus, 17(8), e89736. https://doi.org/10.7759/cureus.89736
  3. Kim, D. H., Ko, D., Singer, D. E., Cervone, A., Zhang, Y., Chen, Q., & Lin, K. J. (2025). Clinical Outcomes of Switching From Warfarin to Apixaban or Rivaroxaban in Patients With Atrial Fibrillation: A Nationwide Multidatabase Study. Circulation. Cardiovascular quality and outcomes, 18(9), e011890. https://doi.org/10.1161/CIRCOUTCOMES.124.011890
  4. Attachaipanich, T., Thanyaratsarun, T., Attachaipanich, S., Danpanichkul, P., & Kaewboot, K. (2025). Efficacy of direct oral anticoagulants vs. warfarin in left ventricular thrombus in myocardial infarction: systematic review and meta-analysis. Journal of cardiovascular medicine (Hagerstown, Md.), 26(1), 40–49. https://doi.org/10.2459/JCM.0000000000001683
  5. Viana, P., Lopes, L. M., Cabral, T. D. D., Persson, J., Tapioca, V. O., Freire, C. V. S., Relvas, J. H., Mesquita, Y., Marques, I. R., & Gomes, W. F. (2025). Warfarin and Aspirin Versus Warfarin Alone in Patients With HeartMate 3 Left Ventricular Assist Device: A Systematic Review and Meta-Analysis. Pacing and clinical electrophysiology : PACE, 48(1), 53–58. https://doi.org/10.1111/pace.15110
 
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