5 Options for When Warfarin No Longer Works for You

How do these medications work? The blood thinner warfarin blocks vitamin K from feeding the different clotting agents in your blood. When you prevent clots, you prevent stroke. These medications don’t block your blood’s ability from clotting completely, though.

Warfarin can be taken long term, if necessary. To keep your blood in a target range for clotting, you’ll need frequent monitoring through a blood test called a prothrombin time test. This test measures how long it takes your blood to clot.

Warfarin interacts with different medications and even with foods high in vitamin K. It may lead to bleeding and even excessive bleeding — internal or external — if not taken correctly or if you get injured.

To avoid complications, it’s important to take warfarin exactly as your doctor prescribes and report any cuts or falls that may put you at risk for bleeding.

Because of the possible complications associated with warfarin, doctors are now recommending non-vitamin K oral anticoagulants (NOACs) over the traditionally prescribed warfarin (Coumadin) as a long-term blood thinner.

NOACs aren’t recommended if you have moderate to severe mitral stenosis or an artificial heart valve.

Warfarin can be effective, but it requires frequent monitoring and may interact with a number of drugs and foods. NOACs don’t need to be frequently monitored and have no known food interactions.

A blood thinner like warfarin might not work for you for several reasons. Before you stop taking it, talk with your doctor.

You may need to make some lifestyle changes to get things working better. Also, newer drugs are available that you might be able to try. If you want to discontinue taking blood thinners altogether, a couple of alternatives may keep your risk of stroke low.

1. Visit your doctor

Call your doctor if you have concerns about warfarin. Explain your side effects or other issues, like drug interactions, and see if they have any advice. If you decide you want to stop taking the medication, your doctor will be able to give you the best instructions on how to do so safely.

Warfarin requires frequent monitoring to see if it’s working well. Before you follow through on your decision to discontinue taking the medication, your doctor may ask you to have a blood test to see if you might need a different dosage.

If that’s not the issue, you can then talk about other options to prevent clotting.

2. Examine your diet

Warfarin may not be working well if you eat certain foods that contain high amounts of vitamin K. These foods include leafy greens like kale, spinach, Swiss chard, and collards.

Supplements like omega-3 fatty acids may also cause issues with warfarin. If you’re eating these foods or taking supplements, changing your routine may help.

There are many healthy foods you can eat that don’t interact with this medication.

For example, sweet potatoes, carrots, and squash are good choices. Your doctor may make suggestions for a diet that will work well with your medication. You may want to ask for a referral to a dietitian who can give you ideas on what foods will complement your treatment plan.

3. Discuss newer drugs

While warfarin was once the most commonly prescribed blood thinner, there are newer drugs on the market.

These drugs, known as NOACs, are likely an option if you live with nonvalvular AFib and are now recommended over warfarin for most people. Your doctor is your best resource to find out if you’re a good candidate. NOACs include:

• dabigatran (Pradaxa)
• rivaroxaban (Xarelto)
• apixaban (Eliquis)
• edoxaban (Savaysa)

Newer drugs are just as effective as warfarin. The difference is that they’re shorter-acting. As a result, they don’t require monitoring as often. They also don’t have as many food and drug interactions, making them a safe choice for your lifestyle.

4. Ask about implants

If you’ve tried other blood thinners and still aren’t satisfied with them, there are alternatives you can discuss with your doctor.

Implants like the WATCHMAN may help reduce your risk of clots without the use of medications. This device blocks off the left atrial appendage in your heart, the area where blood often pools and collects, forming clots.

The WATCHMAN is inserted into your heart through a catheter that starts in your leg. Once it’s in place, it generally takes 45 days for a layer of tissue to grow over it and block the left atrial appendage off completely.

The device is suitable for people who have nonvalvular AFib and who have a good reason for wanting to stop taking blood thinners.

It isn’t recommended to people who already have a clot in their heart, are sensitive to nickel or titanium, or can’t take blood thinners. As a result, you’ll need to talk with your doctor to see if this device is an option for you.

5. And about other procedures

Like the WATCHMAN implant, the LARIAT procedure prevents blood from forming clots in the left atrial appendage. Instead of implanting a device, this procedure uses sutures to tie off the appendage, which eventually turns into scar tissue.

During the procedure, your doctor will numb an area on your chest and insert two catheters through punctures in your skin. This means less pain and faster recovery time versus what you might experience with more serious surgery.

Ask your doctor if the LARIAT procedure may help you discontinue taking blood thinners and reduce your risk of stroke. You might also want to find out if implants and other alternative procedures are covered by your insurance, as they may be costly otherwise.

Before you stop taking warfarin, talk to your doctor about all your options. You may still wish to discontinue using warfarin after discussing lifestyle modifications, changes in dosage, and newer drugs.

The good news is that drug-free alternatives are available. You may be able to prevent blood clots due to AFib and keep your risk of stroke low without medications. The key is keeping the line of communication open with your healthcare team.