Ask the Expert Jamie Cervi-Skinner, PharmD, Clinic Pharmacist, Kootenai Health Anticoagulation Services Q My doctor gave me a prescription for a blood thinner called warfarin (Coumadin) and referred me to the Anticoagulation Services clinic. What is the Anticoagulation Services clinic and why do I need to go there? The Kootenai Health Anticoagulation Services Clinic, often referred to as ACC, has clinical pharmacists who specialize in caring for patients on warfarin. Warfarin dosing must be personalized to each patient and adjusted regularly based on the time it takes your blood to form a clot. The time it takes your blood to clot is measured by a lab test called an INR. At each clinic appointment, an ACC pharmacist will prick your finger with a very small needle to collect blood to check your INR and use that value to adjust your warfarin dose. Each patient has a target INR number range specific to the reason they are taking warfarin. Many patients have a goal INR range of 2 to 3. For a patient with a goal INR range of 2 to 3, an INR value of less than 2 means they are at an increased risk for stroke or a blood clot, whereas an INR value of greater than 3 means they are at an increased risk of bleeding. Q How often will I need to have my INR tested? When you start warfarin, your INR lab will need to be done in the clinic every two to four days for the first 7 to 14 days. After the initial period, your ACC pharmacist will stretch out your appointments depending on how you respond to warfarin and how stable your INR values are. The goal is to stretch clinic visits out to once a month. Q What can affect my INR? • Other medications you are taking—you may need an INR check after starting a new drug or supplement. Always notify your ACC pharmacist of changes. • Foods that are high in vitamin K (think dark green, leafy vegetables)—these are OK to eat, but staying consistent is key. We want you to eat healthy! • Illness, especially fever and lack of appetite, can lead to quick increases in your INR value. Q I’m on warfarin and would like a referral to the ACC. How do I get one? Simple! Ask your primary care provider to send a referral to Kootenai Health Anticoagulation Services, or call the ACC at (208) 625-5688. 22
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