All Things Coumadin: INR Monitoring, Side Effects, & Dietary Recommendations

Coumadin is probably the oldest blood thinner medication that is prescribed to date. Blood thinners or anticoagulants are given to patients that have had blood clots like a pulmonary embolism (PE, blood clot in the lung) or deep vein thrombosis (DVT, blood clot in the lung). Others take Coumadin for a history of stroke, heart attack, and atrial fibrillation. The purpose of Coumadin (which also has other brand names like Warfarin or Jantoven) is to help thin out the blood to reduce a person’s risk for blood clots. 

Initiating Treatment

For someone who is just starting out on Coumadin, there are various ways to do this. Depending on the reason why you’re starting the medication, the treatment may vary. For someone who is being diagnosed with a DVT for the first time, the doctor may have the patient go to the Emergency Room. 

The ER doctor will more than likely start the patient with a Lovenox or Heparin injection first. Those are blood thinner medications that are injected into the belly. Once the patient is sent home, there may be a few more days of injections and then the patient is weaned onto the Coumadin and off of the injections. Again, this is a case by case situation and very dependent on previous medical history and current ailments. 

Other times, your physician may start you out right away on Coumadin, but your “levels” must be checked to ensure you’re not getting too much or not enough of the medication. We will talk about that more in a minute. 

Benefits of Coumadin

Other than reducing your risk for a heart attack or stroke, the medication is quite inexpensive. There are several of my previous patients that have taken Coumadin simply due to the cost of the medication. A few people take the higher priced drugs like Xarelto or Eliquis for most of the year, but when the Medicare donut-hole runs dry they switch to Coumadin because the out of pocket cost of those drugs is ridiculous. 

The medicine is commonly used so the pharmacies seem to keep full stock of this particular drug. It’s not something I’ve heard people having to wait a few days to pick up from their pharmacy because they had to place an order with the manufacturer. 

I can’t remember one time during the past ten years that there was a recall on Coumadin, Warfarin, or Jantoven due to any pharmaceutical error or mistakes. It’s unfortunately quite common with some other prescriptions where the medication that goes out wasn’t actually the medication that was intended. That of course can be quite problematic and scary. 

INR monitoring

The levels we talked about earlier are referring to a blood test called Protime-INR, most of us just call it an INR. For someone that takes Coumadin, their INR levels have to be checked on a routine basis. 

When first starting on Coumadin, it can take upwards of several months to get the levels to fall within normal range. There are exceptions to this where people fall within recommended range by the first week or two, but for others it takes quite a bit longer. 

Most of the doctors will have someone check their INR on a once a month basis, for as long as they are on the medication. For those that have been on the same dose for a long time, they may be able to check their INR every 2-3 months. It just depends on the doctor and the patient on how they want to handle this. 

INR is a simple blood draw and it’s not something you have to be fasting for. This type of test can be done at various places. There are companies now that you can get a hold of that offer in-home INR testing. They send you a monitor and testing supplies, it’s the patient’s responsibility to report results to their doctor. 

Home care also offers INR testing. So if you are currently receiving home care services, the nurse should be able to draw your blood and send it to the doctor once they have the results. Some labs even make house calls, here in Saint Louis, MO the lab I can remember is called Stover labs that does this for patients. 

The other option is to go to a Coumadin Clinic. These types of facilities are usually affiliated with a hospital and they have a doctor on staff that manages the adjustment of the Coumadin medication if needed. 

Typically the doctors that will adjust your Coumadin based on your INR results will be your Cardiologist (heart doctor) or your PCP (primary care provider). Only one doctor needs to receive these results and discuss changing your medication so that there isn’t any confusion. 

Side Effects

Of course, there are risks associated with taking this type of medication, but it far outweighs the risk of not taking it for someone that needs a blood thinner. If you or someone you love is taking Coumadin there are some symptoms that you will need to report to the doctor if they occur. These include:

  • Bleeding of the gums
  • Nose bleeds
  • Blood in the urine
  • Black or tar looking stools
  • Coughing or spitting up blood
  • Excessive or abnormal vaginal bleeding
  • Bleeding from a cut that doesn’t seem to want to stop


My stepdad was previously on Coumadin for a short while after having knee surgery. This was because he wasn’t as mobile so they wanted to make sure he didn’t develop a blood clot while he was laid up. in bed.

When my mom was out of the house at work, he was feeling pretty strong so decided he wanted to take a shower. He ended up falling while in the tub and started to bleed, well when you take Coumadin sometimes the bleeding just won’t let up. 

He managed to make it out of the tub and down to the phone to call an ambulance. He collapsed on the floor in the kitchen. The firefighters had to break into the back door by busting the glass in order to get him to the hospital. 

For a former police officer, the last place you want to be found is naked on the kitchen floor surrounded by a bunch of fire fighters bleeding to death, but that’s where he was. Thanks to their life saving measures and quick thinking my stepdad is still here today. 

The only lesson I have here is to please be careful and take extra precautions while taking this or any other blood thinner medication. Now we’ll jump on into the diet and how it’s important with this medication.

Dietary Recommendations 

There are several people who take Coumadin that aren’t notified of the dietary recommendations associated with this particular medication. Some people will tell you to stay away from Vitamin K rich foods, but that isn’t necessarily the right or wrong answer. If you do not like to eat a diet high in Vitamin K, it’s not encouraged that you do so. But.. If you do like your Vitamin K rich foods, just be sure you’re being consistent in consuming it EVERY DAY to make the medicine work as it should. You can check with your doctor to get clarification on what works best for you. 

Vitamin K rich foods include: Kale, Spinach, Collard greens, Swiss chard, Mustard greens, Parsley, Broccoli, Brussels sprouts, Turnip greens, Endive, Cabbage, green leaf lettuce, Romaine lettuce, Prunes, Asparagus, Avocado, Tuna, Blue/Black Berries, and Peas.   

If you are use to eating a salad every day, just be sure your portion sizes stay consistent because the way that Coumadin works it can go up and down quite rapidly depending on what you’re consuming. 

Alrighty ladies and gents, that’s it for today! If you have any questions about this information feel free to leave a comment below. For those willing to share their experience with this medication we would love to hear from you!

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