The magazine review:

Warfarin (a colourless, crystalline, water-insoluble anticoagulant, C19H16O4) Introduced in 1948 as a pesticide against rats and mice, and is still used for this purpose.

Warfarin was found to be effective and relatively safe for preventing thrombosis and thromboembolism in many disorders. It was approved for use as a medication in 1954, and has remained popular ever since; Warfarin is the most widely prescribed oral anticoagulant drug.

Despite its effectiveness, the treatment with Warfarin has several shortcomings. Many commonly used medications interact with Warfarin, as do some foods (particularly leaf vegetable foods or “greens,” since these typically contain large amounts of vitamin K1) and its activity has to be monitored by blood testing for the international normalised ratio (INR) to ensure an adequate yet safe dose is taken.

A high INR predisposes to a high risk of bleeding, while an INR below the therapeutic target indicates the dose of Warfarin is insufficient to protect against thromboembolic events, and may encourage blood clotting.

When you take Warfarin, your blood won’t clot as easily. If you accidentally cut yourself while taking Warfarin, you may bleed heavily. You’re more likely to have bleeding problems if you’re older than 75 or take other blood-thinning medications that can further increase your bleeding risk.

Warfarin side effects that require immediate medical attention

1) Severe bleeding

Inchcock Not affected at the moment

2) Black stool or bleeding from the rectum

Inchcock affected: Went to see GP, told he had haemorrhoids.

3) Skin conditions such as hives, a rash or itching

Inchcock affected: Mentioned to GP, who prescribed the old git Cetraben cream.

4) Swelling of the face, throat, mouth, legs, feet or hands

Inchcock affected: GP prescribed Furozamide water tablets.

5) Bruising that comes about without an injury you remember

Inchcock affected: Occasionally this happen. Inchcock notices sometimes in a morning, he puts this down to the nightmares he has nightly might have caused him to toss about a bit. He sleeps on the floor to ease his back pain you see.

6) Chest pain or pressure

Inchcock affected: GP put this down to his Angina and Reflux valve, and increased his Angina medication dosage.

7) Nausea or vomiting

Inchcock Not affected:

8) Fever or flu-like symptoms

Inchcock affected: He tells me these seem to be ever present.

9) Joint or muscle aches

Inchcock affected: GP told him to expect these and his Arthritis doesn’t help.

10) Diarrhoea

Inchcock Not affected:

11) Difficulty moving

Inchcock affected: He says every day can be different. As the CP suggested, he gets out for a hobble as often as his condition allows him to. Three/four times a week. Dizzy spells can be a bother to him though.

12) Numbness or tingling in any part of your body

Inchcock affected: Hands fingers and feet are the worst affected.

13) Painful erection lasting four hours or longer

Inchcock affected: Boy of boy… yes, every night! Hence the current bleeding on his Inch.

14) Severe dizziness

Inchcock affected: Not regular pattern, but some days it can be incapacitating to Inchy. GP changed amounts of some of his medications, but the dizzy spells continue.

15) Trouble breathing

Inchcock affected: GP puts this down to his angina and reflux valve.

Less serious Warfarin side effects to tell your doctor about

1) Explosive and unexpected emissions of wind from the anus.

Inchcock affected: Boy is he affected! GP told him to expect this due to the Warfarin, his Reflux Valve sticking and his earlier cancer operation.

2) Feeling cold

Inchcock affected: GP told him to expect this.

3) Fatigue

Inchcock affected: Hence the old man’s falling asleep at any given time. That’s why he lost his driving licence, and nowadays falls asleep at his laptop, on the bus, in the hospital waiting room etc.

4) Pale skin

Inchcock affected: So much so he told me he thought he’d died the other day when he woke up and looked in the mirror.

5) Changes in the way foods taste

Inchcock affected: He has found himself liking food he did not like before going on Warfarin.

6) Hair loss

Inchcock affected: Although his being bald headed makes this a tad difficult to monitor, his chest and underarm hairs have diminished, and his moustache is turning grey.

Although rare, Warfarin can also cause skin tissue death (necrosis) and gangrene requiring amputation. This complication most often happens three to eight days after you start taking Warfarin. If you notice any sores, changes in skin colour or temperature, or severe pain on your skin, notify your doctor immediately.

Inchcock wrote in a very unsteady hand that he had considered looking into the side effect of his many other medications… but had decided against it.