Anticoagulation Clinic at GBMC
Providing education, blood testing and specialized monitoring and medication management to patients taking blood-thinning medications
The goal of the AC Clinic is to provide quality, compassionate care and excellent service, leading to increased medication control and better outcomes.
Surendra Marur, MD, MPH, FACP
Medical Director of the Anticoagulation Clinic
Dr. Marur received his Bachelor of Science degree in Engineering from The University of Michigan before traveling to India to complete his medical education at the Kasturba Medical College in Manipal. He then completed his training in Internal Medicine at Wayne State University/Sinai-Grace Hospital. He joined the Internal Medicine Residency faculty at Sinai-Grace Hospital in Detroit where he also served as their Ambulatory Clinic Director and worked as a primary care physician. He completed his Masters of Public Health from The University of Michigan during his tenure at Sinai-Grace Hospital. When he located to Maryland, Dr. Marur worked as a hospitalist at Frederick Memorial Hospital before joining the faculty at GBMC. His interests include preventive medicine, medical education, and health care management and policy.
Our Team
Our Services
- One-on-one consultation sessions with clinical pharmacists specializing in anticoagulation therapy management
- Onsite blood testing by certified phlebotomists
- Medication list review at each visit
- Coumadin refill authorizations
- Consultation with your primary care physician to ensure appropriate medication regimens
- Appointment reminder calls for every visit
- Warfarin and DOACs (Direct Oral Anticoagulants: Eliquis®, Xarelto®, Savaysa®, Pradaxa®) refill authorizations
Frequently Asked Questions
What is Warfarin and how does it work?
Warfarin is a medication used to prevent your blood from forming clots. It works by blocking your body’s ability to make vitamin K-dependent clotting factors in the liver. These factors are needed for your body to form clots.
How do I know my Warfarin is working?
At each visit to the AC Clinic, a lab test known as an INR will be administered. INR stands for international normalized ratio. It is used to determine the amount of time it takes your blood to clot while taking warfarin. Your required dose of warfarin will depend on this value and your goal INR range. If you fall below your goal range, your blood may be too thick, which could increase the chances of a clot forming. If your result is above your goal INR range, your blood may be too thin, which could increase your risk of bleeding. INR lab results are ready within one minute, which enables an AC pharmacist to make quick dosage adjustments while you are still at the Clinic. When used correctly, warfarin is safe and effective for patients.
What are DOACs (Direct Oral Anticoagulants) and how do they work?
DOACs or Direct Oral Anticoagulants, are a newer class of anticoagulant medications that prevent your blood from forming clots and may prevent existing clots from getting bigger. Some examples of DOAC medications include: Apixaban (Eliquis®), Rivaroxaban (Xarelto®), Edoxaban (Savaysa®) and Dabigatran (Pradaxa®).
How do I know my DOAC medication is working?
It is important to monitor yourself for signs of new clots as follows:
Stroke: “F.A.S.T.”
- Face: one sided facial droop, sudden vision changes and severe headache
- Arms: one arm drifting downward when raising both arms, numbness on one side of the body
- Speech: difficulty speaking or understanding others
- Time: Call 911, if having any of these symptoms
DVT (Deep vein thrombosis)
- New leg pain, swelling, redness or warmth
PE (Pulmonary embolism)
- New unexplained shortness of breath, rapid heartbeat or chest pain
Seek immediate medical attention by calling your provider or going to the emergency room.
How are DOACs different from warfarin?
- Works in the body differently than warfarin
- Less interactions with food
- No INR testing
- Less frequent clinic visits
- More expensive than warfarin
- Higher co-pays
- Less frequent/minimal dosing adjustments
- Reversibility of a bleeding event is more challenging
What if I miss a dose?
It is important to take your anticoagulation medication every day, at the same time. If you forget a dose, only take the missed dose as soon as possible if you remember within the same day. DO NOT take a double dose the next day to catch up. Simply document the missed dose and notify your AC Clinic clinician during your next visit.
What pain-relieving medications can I take while on warfarin or a DOAC?
You should take acetaminophen (Tylenol) for aches, pains, fever or headache unless you are allergic or have a pre-existing medical condition that does not allow you to take it. Consult your AC Clinic clinician or primary care physician regarding a safe dosage while taking warfarin or a DOAC.
What medications should I avoid?
DO NOT take aspirin, ibuprofen (Motrin, Advil) or naproxen (Aleve) unless your physician tells you to do so. These products can cause you to bleed more easily. Many over-the-counter cough and cold medications also contain aspirin or ibuprofen. Pepto-Bismol can also cause you to bleed more easily. Always check with your doctor, pharmacist or with the AC Clinic before taking any new OTC or prescription medications. If you consume alcohol while taking warfarin or a DOAC, please do so in moderation and let your clinician know so they will be able to better manage your therapy.
Who should I tell about my medications?
Many drugs can affect the effects of warfarin and to a lesser extent, DOACs. Always make sure your physician, dentist, and pharmacist know that you are taking an anticoagulant medication. Notify the AC Clinic when you start any new medications as dosage adjustments may be needed to compensate for the new medication. In case of emergency, it is advisable to wear a medical alert bracelet or carry a patient identification card that states you are taking an anticoagulant medication.
When should I seek medical attention?
You should seek medical attention immediately if you notice any of the following:
- Unusual bleeding
- Blood in stool or black, tarry stools
- Red or unusually dark-colored urine
- Excessive or unexplained bruising
- Any injury or fall
- Any sudden or extremely painful headache
- Any sudden weakness/numbness on one side of the body
- Unexplained shortness of breath
- Chest pain or chest pressure
- Sudden changes in vision or speech
Why is Vitamin K so important to Warfarin?
Vitamin K reverses the effect of warfarin so if you constantly change the amounts you eat, it can greatly affect your therapy. That is why it is important to maintain a consistent diet with respect to foods high in Vitamin K.
Vitamin K-rich foods include most green leafy vegetables such as spinach, kale, collard greens, turnip greens and lettuce as well as broccoli, cauliflower, cabbage, Brussels sprouts, green herbal teas, mayonnaise and liver.
Do I have to worry about Vitamin K or any other dietary restrictions with DOACs?
There are currently no dietary restrictions with DOACs.
What do I need to do as a patient of the Anticoagulation Clinic?
At your first visit, please bring a list of your current medications and provide your primary care physician’s contact information. This information is important for your clinician in evaluating and recommending an appropriate dose of warfarin or a DOAC, as well as in the case of possible drug interactions. It is very important that you keep your appointments. If you are unable to keep an appointment for any reason, please notify us at 443-849-2769.
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