Important Phone Numbers. Topic Contents Overview How can you care for yourself at home? When should you call for help? Where can you learn more? Top of the page. Overview You had a blood test to check how long it takes your blood to clot. How can you care for yourself at home?
Be careful with medicines and foods Don't start or stop taking any medicines or natural health products unless you first talk to your doctor. Keep the amount of vitamin K in your diet about the same from day to day. Do not suddenly eat a lot more or a lot less food that is rich in vitamin K than you usually do.
Vitamin K affects how warfarin works and how your blood clots. Limit your use of alcohol. Avoid bleeding by preventing falls and injuries Wear slippers or shoes with non-skid soles. Remove throw rugs and clutter. Rearrange furniture and electrical cords to keep them out of walking paths.
Keep stairways, porches, and outside walkways well lit. Mistakenly increasing the warfarin dose by too much could land your patient in the ICU with a serious bleed or worse. Keeping the dose too low, on the other hand, places your patient at risk for serious complications like stroke.
So, how do you win when it comes to managing warfarin? If you treat anticoagulated patients as a nurse practitioner, careful attention to coagulation status is a must. There are a number of reasons to tease out. So, before you increase of decrease warfarin dose, consider these five factors. Remembering to take medications is difficult. Remembering to take medications at the same time, in the same manner each day even more so. INR effects can be seen relatively quickly in the case of a missed dose.
Warfarin acts on a number of clotting factors with half lives between 6 and 60 hours. So, you begin to see the effects of a skipped or adjusted dose start within a day and peak at about five days.
Did the patient start, stop or change any other medications? There are two primary ways that such medications interact with warfarin and therefore INR:. Inducers — Medications that induce, or rev up, this metabolic pathway increase warfarin metabolism rendering the med less effective. So, INR decreases. Inhibitors — Inhibitors block or slow the pathway that metabolizes warfarin so the drug builds up in the system and circulates longer.
With warfarin metabolism decreased i. If the patient forgets a dose, do they "double up" the dose to offset the missed dose? If the INR is unexpectedly low, inquire about medication compliance. It is important to emphasize that patients must call the healthcare provider for advice if they miss a dose Hull et al. Has there been a recent warfarin brand change? Because warfarin is absorbed quickly, there have been rare instances when substituting brands could alter the INR Enwere et al.
Patients should be advised to remain consistent with one brand. Has the patient recently initiated or stopped any prescriptions? INRs can increase if a patient has been prescribed antibiotics Enwere et al. This usually happens within 1 week of therapy initiation and the interaction magnitude is unpredictable. To be cautious, the INR should be monitored more frequently for a few weeks when discontinuing or initiating a new prescription Hull et al.
Also, inquire about vitamins, herbals, or nonprescriptions medication. Many patients do not recognize these as medications. Clinicians also consider how quickly and to what extent the anticoagulation needs to be reversed.
Any requirement for warfarin reversal therapy can serve as an opportunity to review whether warfarin treatment is still necessary for the patient. Local guidelines may also exist, such as those for hospitals in the north of England on which this article is based. Where patients are asymptomatic ie, not bleeding , their INR is used to determine the need for treatment. Regardless of which treatment is used, it is important to increase the frequency of INR monitoring until it returns to the desired range.
Asymptomatic patients with an INR that is only slightly above the therapeutic maximum can often be managed simply by omitting their usual warfarin dose and increasing their frequency of INR monitoring.
The INR will reduce over several days. Warfarin should be restarted, if necessary, when the INR falls below 5. For such patients, mg of phytomenadione should be given orally as well as omitting their warfarin dose.
Asymptomatic patients with an INR above 8. If the INR is greatly above 8. Haemorrhage can occur even when the INR is within its intended range. For bleeding patients, the severity of haemorrhage governs whether or not warfarin reversal treatment is used and the type of treatment — not the INR level. Minor bleeding would include patients who present with bruising or epistaxis of limited duration. Anticoagulated patients who are experiencing minor bleeding should have their warfarin doses omitted and be given 2mg of oral phytomenadione.
If the patient has a significantly high INR above 8. Major bleeding can be subdivided into two categories. First is haemorrhage that poses a risk to life, limb or sight. This includes intracranial, retroperitoneal, intraocular, pericardial and muscular bleeding. Second is haemorrhage that does not cause major haemodynamic compromise i.
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