How do you manage Coumadin levels?

Current INR is 5–9

  1. Stop warfarin.
  2. Test INR daily until it has returned to the therapeutic range.
  3. Restart warfarin with a reduced dose when INR < 5.
  4. Give vitamin K 1.0 – 2.5 mg, orally if INR fails to reduce, or if there is high risk of serious bleeding (N.B. subcutaneous administration is not effective)

When is bridging therapy necessary?

The intent of bridge anticoagulant therapy is to minimize both the risk of thromboembolic events and the risk of bleeding during the peri-operative period. Bridging anticoagulant therapy is appropriate for some but not all patients undergoing medical procedures.

How do you adjust Coumadin based on INR?

How should you adjust her warfarin dose? According to the table at the bottom of the flow sheet, you should lower the dose 5 to 10 percent and recheck the INR in seven to 14 days. You therefore lower her dose to 37.5 mg (2.5 ÷ 40 = 6.3 percent) and have her come back in 10 days for a recheck.

How often should warfarin levels be checked?

When you first start warfarin, you may need to have blood tests every few days or weekly. When your INR and warfarin dose are stable, blood tests are often done every 2 to 4 weeks, sometimes longer. If your dose changes you may need to have your INR tested more often.

When should I stop bridging warfarin?

Warfarin therapy should be stopped five days before major surgery and restarted 12 to 24 hours postoperatively. Bridging with low-molecular-weight heparin or other agents is based on balancing the risk of thromboembolism with the risk of bleeding.

How do you bridge Coumadin?

How Is Bridging Anticoagulation Given? After warfarin is stopped, 5 to 6 days before surgery (to allow sufficient time for its anticoagulant effect to wane), bridging anticoagulation is started 3 days before surgery, with the last dose given 24 hours before surgery.

When do you give vitamin K for elevated INR?

What dose and route of administration should be used? For most warfarin-treated patients who are not bleeding and whose INR is >4.0, oral vitamin K (in doses between 1 and 2.5 mg) will lower the INR to between 1.8 and 4.0 within 24 hours.

Do you hold warfarin if INR is high?

Elevated INRs between 4.5 and 10, and not associated with bleeding or a high risk of bleeding, can be safely managed by withholding warfarin and carefully monitoring the INR.

Do you give warfarin if INR is low?

Your warfarin dose may need to be lowered. Low INR: If your INR is too low, you are at increased risk of blood clots forming and your warfarin dose may need to be increased.

How should patients taking warfarin (Coumadin) be treated?

Patients taking warfarin (Coumadin) should be treated using systematic processes of care to optimize effectiveness and minimize adverse effects. Health care professionals skilled in the initiation and assessment of therapy and dosing adjustments can dramatically influence outcomes.

How is vitamin K (grade 2C) administered with warfarin (Coumadin)?

Hold warfarin (Coumadin) and administer vitamin K (grade 2C), increase frequency of monitoring, repeat vitamin K as necessary, and resume warfarin at an appropriate dosage when INR is within the therapeutic range 2.5 to 5 mg orally as one dose

What is the basis for initiating anticoagulation in patients with oral warfarin?

Many physicians continue to use clinical judgment alone as the basis for initiating and adjusting warfarin dosages in patients who require oral anticoagulation. A number of studies have validated approaches to initiation of anticoagulation that provide more rapid anticoagulation with less chance of complications.

What are the alternatives to the management of anticoagulation in primary care?

Two alternatives to the management of anticoagulation in the primary care office are anticoagulation management services (AMS) and patient self-monitoring (PSM); the latter uses home testing of the International Normalized Ratio (INR).