Patient was educated on effects of protein on Coumadin function as follows:

• Coumadin is a drug that can be highly bound to protein. Protein bound drug cannot exert the anticoagulant effect and it is the unbound free form of Coumadin that is effective as an anticoagulant.
• So, any mechanism that will influence the protein binding of Coumadin, will influence the anticoagulant behavior of the medication.
• For example, a diet high in protein can result in high protein binding of the drug, as more protein is available for the drug to bind. This will decrease the free unbound form of the drug and so, results in less anticoagulation and more risk for clotting.
• Alcohol can compete with Coumadin for protein binding and take up some sites on protein for binding. This leaves freer form of Coumadin available for anticoagulation, increasing the risk for bleeding. So, alcohol consumption along with this medication is strongly discouraged.