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Frequency not reportedUnexplained decrease in hematocrithemoglobin decreasedRef]

For patients with a bileaflet mechanical valve or a Medtronic HallMinneapolisMNtilting disk valve in the aortic position who are in sinus rhythm and without left atrial enlargementtherapy with warfarin to a target INR of 2.5range2.0-3.0is recommendedFor patients with tilting disk valves and bileaflet mechanical valves in the mitral positiontherapy with warfarin to a target INR of 3.0range2.5-3.5is recommendedFor patients with caged ball or caged disk valvestherapy with warfarin to a target INR of 3.0range2.5-3.5is recommendedFor patients with a bioprosthetic valve in the mitral positiontherapy with warfarin to a target INR of 2.5range2.0-3.0for the first 3 months after valve insertion is recommendedIf additional risk factors for thromboembolism are presentAFprevious thromboembolismleft ventricular dysfunctiona target INR of 2.5range2.0-3.0is recommended.

VKORC1 and CYP2C9 gene variants generally explain the largest proportion of known variability in warfarin dose requirements.

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COUMADIN is contraindicated in women who are pregnant except in pregnant women with mechanical heart valveswho are at high risk of thromboembolismsee WARNINGS AND PRECAUTIONS and Use In Specific PopulationsCOUMADIN can cause fetal harm when administered to a pregnant womanCOUMADIN exposure during pregnancy causes a recognized pattern of major congenital malformationswarfarin embryopathy and fetotoxicityfatal fetal hemorrhageand an increased risk of spontaneous abortion and fetal mortalityIf COUMADIN is used during pregnancy or if the patient becomes pregnant while taking this drugthe patient should be apprised of the potential hazard to a fetussee Use In Specific Populations

As heparin may affect the INRpatients receiving both heparin and COUMADIN should have INR monitoring at least:

These are not all of the side effects of COUMADINFor more informationask your healthcare provider or pharmacistCall your doctor for medical advice about side effectsYou may report side effects to FDA at 1800-FDA-1088.

VKORC1 and CYP2C9 gene variants generally explain the largest proportion of known variability in warfarin dose requirements.

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