health and safety


liver disease and warfarin

Both procoagulants and anticoagulants that occur naturally in the body are produced by the liver, affecting your INR. When you take your warfarin, it gets processed by the liver.

The liver is one of the most important organs in your body. Every single thing you eat and drink is filtered through your liver or your kidneys, but the liver is your body’s most effective filter. The liver filters out what the body can use then sends what the body doesn’t need down through the rest of the digestive tract for removal. Both procoagulants and anticoagulants that occur naturally in the body are produced by the liver, affecting your INR. When you take your warfarin, it gets processed by the liver. The liver is also very resilient. It is the only organ with the ability to regenerate itself. It’s the Wolverine of the human body. One could have part of his/her liver removed and the missing part would eventually grow back.

Anticoagulation Monitoring and Liver Disease

It’s one thing to have a heart condition which requires you to be on warfarin, but it’s another to throw liver disease in the mix. This requires much more caution for patients and health care professionals. Liver disease, especially chronic liver disease such as cirrhosis or cancer, puts a patient at a much higher risk for bleeding. When the liver becomes so damaged it can no longer heal itself, it loses the ability to produce enough of the clotting factors that stop someone from bleeding after being cut. Many patients with chronic liver disease suffer from frequent internal bleeding, usually in the stomach or intestine.

If you need to be on anticoagulation therapy and have liver disease, it is very important you be proactive in your own care. If you monitor your INR at home, check your INR as instructed by your doctor and take it at the same time of day every day. You also need to take your warfarin exactly as instructed by your doctor. Be sure to plan your schedule so as not to miss any of your tests or doctors’ appointments. You may have multiple providers so keep track of who you see and when as this will help all of your doctors to stay on top of your condition and make any necessary changes in a timely manner.

If you are unsure on what you can eat and not eat (with liver disease, one must limit sodium intake) or if you want to take a vitamin, supplement or any over the counter medication, ask your doctor first. Pills bought at the store may interact with any prescribed medication you are currently taking. Finally, keeping a record of all medications you are taking is very important. Keeping track of prescriptions from multiple providers can be especially challenging. Even when you know the names of the prescriptions, many people are not aware of the dosages. You can fill out your information in a log book or with our Medication List Form to keep this information handy. If your doctor changes the dosage of a medication you are taking, update the information as soon as you can. Having the most complete and accurate information for you doctors will help them keep you from having complications.


Herrine, S.K., M.D. Liver Failure. Merck Manual, Consumer Version. 2015. Retrieved from website: manifestations-of-liver-disease/liver-failure.

Mayo Clinic Staff. Diseases and Conditions: Acute Liver Failure – Complications. Mayo Clinic. July 10, 2014. Retrieved from website: liver-failure/basics/complications/con-20030966.

Efird, L.M. et al. Stratifying the Risks of Oral Anticoagulation in Patients with Liver Disease. Circulation: Cardiovascular Quality and Outcomes. 2014 May;7(3):461-7. doi: 10.1161/CIRCOUTCOMES.113.000817. Epub 2014 May 13. Retrieved from website:

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