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Call 425-899-2783

Virtual visits are available for some appointments.

Anticoagulation Management

If you are living with blood clots or are at risk of developing blood clots, your provider may prescribe an anticoagulant to treat your condition.

You may also be referred to the EvergreenHealth Pharmacist Provider Services for management of your medication in order to prevent bleeding or clotting complications.

Common reasons you may take an anticoagulant include:

  • Deep vein thrombosis
  • Pulmonary embolism
  • Certain types of stroke
  • Atrial fibrillation
  • Certain types of artificial heart valves
  • Genetic predisposition to form clots

Common anticoagulant medications include:

  • Warfarin (Coumadin®, Jantoven®)
  • Dabigatran (Pradaxa®)
  • Rivaroxaban (Xarelto®)
  • Apixaban (Eliquis®)
  • Edoxaban (Savaysa®)
  • Enoxaparin (Lovenox®)
  • Dalteparin (Fragmin®)

Regardless of the reason for taking an anticoagulant, close monitoring is necessary to prevent complications.

Our Program

EvergreenHealth Pharmacist Provider Services is staffed by clinical pharmacists who are anticoagulation experts.

The pharmacist may work with you and your physician to select the best anticoagulant for your health conditions.

If you are treated with warfarin, the pharmacist will work with you to closely monitor this therapy, perform the necessary laboratory testing, adjust the warfarin dose, and safely manage potentially dangerous drug interactions.

At each clinic visit, the pharmacist will:

  • Screen for drug interactions. There are numerous medications, dietary supplements, vitamins and herbal products that can affect the way anticoagulants work in your body, so it is very important that we maintain a complete list of all prescriptions, over-the-counter (OTC) medications, vitamins, dietary supplements and herbal products.
  • Assess lifestyle changes. Changes in diet, activity and consumption of alcohol can impact the warfarin dose requirement. Recent illness, antibiotics, and stress can potentially change the way an anticoagulant will work in your body.
  • Perform necessary laboratory tests. For warfarin management, a finger stick test is performed at your clinic visit to measure the INR (international normalized ratio), and provides a measure of blood clotting. For management of other anticoagulants, the pharmacist may order lab tests (such as a kidney function test) when needed.
  • Adjust the anticoagulant dose if needed. For warfarin management, based on the INR and an assessment of any medication, lifestyle, or clinical changes, the pharmacist may need to adjust the warfarin dose. The pharmacist will give you a printed medication plan. INR results and any dosage adjustments are forwarded to your physician to keep them fully informed.

Return visits with the pharmacist will be scheduled as needed based on your clinical condition and the anticoagulant that you are being treated with.

Warfarin Tablet Colors

Wararin tablet colors

About Taking Warfarin

If I am asked by the Pharmacist Provider Services pharmacist to get my INR checked on the weekend, which lab should I go to?

The following labs are available to check your INR on the weekend:

Saturdays:
LabCorp located on the 5th floor of the main hospital building, Coral section, suite 520
Hours: 7 a.m. – 3:30 p.m.
Phone: 1.800.598.2796

Sundays:
Main hospital lab located in the Purple zone, room 1-374.
Instructions: enter the hospital from the Central parking garage and take the escalator down to the first floor. Follow the signage to the Purple zone. Purple 1-374 will be on your left. Pick up the telephone by the entrance and state that you’re there for a blood draw.

When should I page the on call pharmacist?

You may page the on call pharmacist on weekends or after hours if you:

  • Have unusual bleeding/bruising
  • Miss a dose of warfarin or take an incorrect dose
  • Have an illness with fever, vomiting, or diarrhea
  • Are prescribed a new medication
  • Run out of your supply of warfarin and have no refills available
  • You have any other concerns which require consultation.

When should I go to the ER?

Please go to the ER if you:

  • Fall or hit your head
  • Have a nosebleed that doesn’t stop after applying direct pressure and an icepack
  • Have significant blood in your urine or stool
  • Are vomiting what looks like coffee grounds
  • Are experiencing symptoms that may indicate a new or worsening blood clot (pain, swelling, redness or warmth in the arms or legs)

When should I call 911?

  • Chest pain or difficulty breathing
  • Signs or symptoms of stroke such as:
    • Sudden weakness or numbness of the face, arm, or leg on one side of the body
    • Sudden dimness or loss of vision, particularly in one eye
    • Loss of speech, or trouble talking or understanding speech
    • Sudden, severe headaches with no apparent cause
    • Unexplained dizziness, unsteadiness, or sudden falls, especially along with any of the previous symptoms

How many green vegetables should I eat while on warfarin?

Vitamin K is found in many foods, especially green, leafy vegetables. Vitamin K lowers the INR, whereas warfarin raises the INR.

You can decide the amount of green vegetables you’d like to eat on a weekly basis and try to stay as consistent as possible. You should pay most attention to the dark green leafy vegetables, which are high in vitamin K.

Our clinic will work with you to find a warfarin dose that can balance the vitamin K in your diet and help keep the INR stable.

What is My Navigator and how do I use it?

My Navigator is the patient portal that securely connects you with your EvergreenHealth electronic health record.

If you have a question for your Pharmacist provider, you can send an email via My Navigator. The question will be answered within the next business day. To ensure a prompt reply, your question will be answered by any available pharmacist.

How to Get Started

We welcome patients at any stage of anticoagulation therapy; you will need a physician referral to become a patient at EvergreenHealth Pharmacist Provider Services.

Download our referral form for anticoagulation therapy