- With Mayo Clinic emeritus hypertension specialist
Sheldon G. Sheps, M.D.
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Sheldon G. Sheps, M.D.
Sheldon G. Sheps, M.D.
Dr. Sheldon Sheps, emeritus professor of medicine and former chair of the Hypertension Division in the Department of Medicine at Mayo Clinic, has been with Mayo Clinic since 1960.
Dr. Sheps, a Winnipeg, Manitoba, native, is board certified in internal medicine and specializes in hypertension and peripheral vascular diseases. He developed a multidisciplinary approach with specially trained nurses, dietitians, technicians and educators to help form a team approach to the treatment of patients with abnormal blood pressure.
"I have always believed in involving the patient and family in their health care," he says. "I have asked for their understanding of the illness and issues and for participation in decisions. The Web is a natural extension of that, and now many more people can be informed."
Dr. Sheps chaired the sixth working group, and participated in the fourth, fifth and seventh groups, that developed the then-latest guidelines for hypertension under the auspices of the National Heart, Lung and Blood Institute (NHLBI). He helped write the latest American Heart Association (AHA) report on blood pressure measurement. He chaired an AHA group that produced an online accreditation for blood pressure measurement for health professionals. He has co-authored books, newsletters, CD-ROMs and other Mayo Clinic health information material and joined Mayo Clinic's Web team in 1998. He was medical editor-in-chief of both editions of the "Mayo Clinic on High Blood Pressure" book; the last edition was published in 2003. He was also medical editor-in-chief of "Mayo Clinic 5 Steps to Controlling High Blood Pressure,'' published in 2008.
He was section editor for each of the first three editions of "Hypertension Primer" for the American Heart Association.
Dr. Sheps was also chairman of the Science Base Subcommittee, National High Blood Pressure Education Program, and was a consultant to the Hypertension Initiative of the World Health Organization. In 1997, he was honored with the Individual Achievement Award on the 25th anniversary of the National High Blood Pressure Education Program of NHLBI. In 2009, he was honored as a Distinguished Mayo Alumnus.
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Question
Warfarin: Any harm in long-term use?
Is there any harm in taking warfarin for an extended period? My doctor prescribed it after I had an episode of deep vein thrombosis. I'd like to continue taking it for peace of mind.
Answer
from Sheldon G. Sheps, M.D.
Warfarin (Coumadin) is a blood-thinning medication (anticoagulant) used to treat and prevent blood clots. For most people with a single episode of deep vein thrombosis (DVT), treatment with full-dose blood thinners is usually for only a limited time.
Long-term, low-dose treatment with warfarin may prevent future episodes of DVT, but it's not without risk. There's a risk of serious or even fatal bleeding — especially when warfarin is taken in high doses or for long periods of time. Taking warfarin at a high dose for a longer period of time is only recommended for people who are at a high risk of developing blood clots that could cause a heart attack, stroke or pulmonary embolism.
Ask your doctor to help you weigh the benefits and risks of long-term low-dose warfarin therapy in your case. Also consider these self-care measures to prevent future episodes of DVT:
- Avoid sitting, squatting or crossing your legs for long periods of time.
- If you must sit for long periods, such as during a plane or car ride, take a short walk every hour. It also helps to flex your ankles, curl your toes and tap your feet frequently.
- Drink plenty of fluids to prevent dehydration.
- Wear support hosiery or compression stockings, available at medical supply stores.
If you're taking warfarin to prevent blood clots that could cause a heart attack or stroke, make sure you take it exactly as prescribed. Warfarin is a powerful medication that can have dangerous side effects.
- Ridker PM, et al. Long-term, low-intensity warfarin therapy for the prevention of recurrent venous thromboembolism. New England Journal of Medicine. 2003;348:1425.
- Kearon C, et al. Comparison of low-intensity warfarin therapy with conventional-intensity warfarin therapy for long-term prevention of recurrent venous thromboembolism. New England Journal of Medicine. 2003;349:631.
- Kearon C, et al. Influence of thrombophilia on risk of recurrent venous thromboembolism while on warfarin: Results from a randomized trial. Blood. 2008;112:4432.
