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Coumadin: Serious Side Effects and Patient Education

Patients prescribed Coumadin (Warfarin) must have periodic lab tests to prevent serious side effects including internal bleeding.  When a a patient is prescribed Coumadin the doctor should order frequent laboratory test to carefully determine the therapeutic dose. Too little Coumadin may result in dangerous blood clots.  Too much Coumadin can cause internal bleeding.  The laboratory measures how rapidly the blood clots.  A formula called the International Normalized Ratio (INR) is used to obtain consistent laboratory results from different laboratories.  For most patients, the goal is to obtain an INR of 2.0-3.5.

A study by Johns Hopkins Medical Institution found that 24% of patients on Coumadin did not know that they were supposed to have their labs checked every month.  Over 60% did not know their goal INR, so Johns Hopkins did a study of the effects of improving patient education.  The results were astonishing.  In an eight month period there was only one Coumadin related hospitalization compared with 10 such hospitalizations in the prior eight months.

The point is that patients need to be educated.  In a recent blog post I discussed a study that found a high rate of emergency room patients who did not understand their diagnosis or their discharge instructions.  Managed care and low reimbursement rates by health insurers (including Medicaid and Medicare) have pushed doctors to spend less time talking to their patients.  This has resulted in increased injuries and illnesses.

We have seen the tragic results of doctors and nursing homes failing to properly monitor patients on Coumadin.  If you or a family member has been injured due to a doctor's failure to monitor laboratory results, please call us at (804) 288-1661 or click here to email us.  We represent patients and their families throughout Virginia including in Richmond, Charlottesville, Petersburg, Lynchburg, Fredericksburg, Norfolk, Williamsburg, Hampton Roads and northern Virginia.

Joshua Silverman