Coumadin / warfarin

Assessment for Coumadin / warfarin

Assess for signs of bleeding and hemorrhage (bleeding gums; nosebleed; unusual bruising; tarry, black stools; hematuria; fall in hematocrit or BP; guaiac-positive stools, urine, or nasogastric aspirate). Assess for evidence of additional or increased thrombosis. Symptoms depend on area of involvement.

generic name is warfarin

trade / brand name is Coumadin

Action / therapeutic effects for Coumadin / warfarin

Action Interferes with hepatic synthesis of vitamin K-dependent clotting factors (II, VII, IX, and X). Therapeutic Effect(s): Prevention of thromboembolic ev

Adverse Reactions/Side Effects for Coumadin / warfarin

Adverse Reactions/Side Effects Derm: dermal necrosis GI: cramps, nausea GU: CALCIPHYLAXIS Hemat: BLEEDING Misc: fever

teaching for Coumadin / warfarin

Advise patient to report any symptoms of unusual bleeding or bruising (bleeding gums; nosebleed; black, tarry stools; hematuria; excessive menstrual flow) and pain, color, or temperature change to any area of your body to health care professional immediately. Patients with a deficiency in protein C and/or S mediated anticoagulant response may be at greater risk for tissue necrosis. Instruct patient not to drink alcohol or take other Rx, OTC, or herbal products, especially those containing aspirin or NSAIDs, or to start or stop any new medications during warfarin therapy without advice of health care professional.

Contraindication/Precautions for Coumadin / warfarin

Contraindication/Precautions Contraindicated in: Uncontrolled bleeding; Open wounds; Active ulcer disease; Recent brain, eye, or spinal cord injury or surgery; Severe liver or kidney disease; Uncontrolled hypertension; OB: Pregnancy (may cause fetal harm). Use Cautiously in: Malignancy; Patients with history of ulcer, liver disease, or acute kidney injury; History of poor compliance; Asian patients or those who carry the CYP2C9*2 allele and/or the CYP2C9*3 allele, or with the VKORC1 AA genotype (↑ risk of bleeding with standard dosing; lower initial doses should be considered); Rep: Women of reproductive potential; Pedi: Has been used safely in children, but may require more frequent PT/INR assessments; Geri: Due to greater than expected anticoagulant response, initiate and maintain at lower doses in older adults.

Implementation for Coumadin / warfarin

Implementation High Alert: Do not confuse Coumadin (warfarin) with Avandia (rosiglitazone) or Cardura (doxazosin). Do not confuse Jantoven (warfarin) with Janumet (sitagliptin/metformin) or Januvia (sitagliptin). Because of the large number of medications capable of significantly altering warfarin's effects, careful monitoring is recommended when new agents are started or other agents are discontinued. Interactive potential should be evaluated for all new medications (Rx, OTC, and herbal products). PO Administer medication at same time each day. Medication requires 3-5 days to reach effective levels; usually begun while patient is still on heparin.Do not interchange brands; potencies may not be equivalent.

Evaluation/Desired Outcomes for Coumadin / warfarin

Evaluation/Desired Outcomes Prolonged PT (1.3-2.0 times the control; may vary with indication) or INR of 2-4.5 without signs of hemorrhage.

indications for Coumadin / warfarin

Indications Prophylaxis and treatment of: Venous thrombosis, Pulmonary embolism, Atrial fibrillation with embolization. Management of myocardial infarction: Decreases risk of death, Decreases risk of subsequent MI, Decreases risk of future thromboembolic events. Prevention of thrombus formation and embolization after prosthetic valve placement.

Lab Test Considerations: for Coumadin / warfarin

Lab Test Considerations: Monitor PT, INR, and other clotting factors frequently during therapy; monitor more frequently in patients with renal impairment. Therapeutic PT ranges 1.3-1.5 times greater than control; however, the INR, a standardized system that provides a common basis for communicating and interpreting PT results, is usually referenced. Normal INR (not on anticoagulants) is 0.8-1.2. An INR of 2.5-3.5 is recommended for patients at very high risk of embolization (for example, patients with mitral valve replacement and ventricular hypertrophy). Lower levels are acceptable when risk is lower. Heparin may affect the PT/INR; draw blood for PT/INR in patients receiving both heparin and warfarin at least 5 hr after the IV bolus dose, 4 hr after cessation of IV infusion, or 24 hr after subcut heparin injection. Asian patients and those who carry the CYP2C9*2 allele and/or the CYP2C9*3 allele, or those with VKORC1 AA genotype may require more frequent monitoring and lower doses.

Toxicity and Overdose: for Coumadin / warfarin

Toxicity and Overdose: Withholding 1 or more doses of warfarin is usually sufficient if INR is excessively elevated or if minor bleeding occurs. If overdose occurs or anticoagulation needs to be immediately reversed, the antidote is vitamin K (phytonadione, Aquamephyton). Administration of whole blood or plasma also may be required in severe bleeding because of the delayed onset of vitamin K.

therapeutic class for Coumadin / warfarin

anticoagulants

Pharm. Class. for Coumadin / warfarin

coumarins