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Bleedinge.gappearance of blood in stools or urinehematuriaexcessive menstrual bleedingmelenapetechiaeexcessive bruising or persistent oozing from superficial injuriesunexplained fall in hemoglobinis a manifestation of excessive anticoagulation.

Your doctor may want to do a blood teststop the warfarinor prescribe medication to stop the bleeding.

The following serious adverse reactions to COUMADIN are discussed in greater detail in other sections of the labeling:

You should not take Coumadin if you are prone to bleeding because of a medical conditionif you have an upcoming surgeryor if you need a spinal tap or epiduralDo not take Coumadin if you cannot take it on time every day.

The S-enantiomer of warfarin is mainly metabolized to 7-hydroxywarfarin by CYP2C9a polymorphic enzymeThe variant allelesCYP2C9*2 and CYP2C9*3result in decreased in vitro CYP2C9 enzymatic 7-hydroxylation of S-warfarinThe frequencies of these alleles in Caucasians are approximately 11and 7for CYP2C9*2 and CYP2C9*3respectively.

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