Patient with warfarin treatment and you want to do surgery, when you can do.. When PT is 1 – 1.5 INR on the same day

Patient with warfarin treatment and you want to do surgery, when you can do:

1. When PTT is 1 – 1.5 INR on the same day.
2. When PTT is 2 – 2.5 INR on the same day.
3. When PT is 1 – 1.5 INR on the same day.
4. When PT is 2 – 2.5 INR on the same day.

Warfarin is an anticoagulant drug that is also known as Coumadine, Jantoven, Marevan, Lawarin and Waran.

Initially marketed as a rodent pesticide, it was soon found to have advantageous qualities in the prevention of thrombosis and embolism. It has been recognized for medical use for over fifty years and continues to be a generally used anticoagulant medicine worldwide today.

Pharmacology:

Warfarin works to decrease coagulation and, as a result, thrombosis and embolism more low-risk, by inhibiting the enzyme that is responsible for the oxidation of vitamin K in the liver.
Vitamin K is important for the normal process of coagulation, which is why warfarin affects the process of blood clots and reduces the risk of thrombosis.

Benefits and risks:

In making the therapeutic decision of whether warfarin is warranted, it is prudent to consider both the benefits of the risks of taking the drug.

The primary benefit of warfarin is the reduced coagulation factors and the relative moderate risk of thrombosis. The value of this benefit varies depending on the probability of the patient suffering from this condition and the severity if it occurs. People with a family history of deep vein thrombosis, for example, may benefit more from the use of warfarin, as well as those with concurrent medical conditions, such as heart disease or a previous rape.

This advantage must then be weighed against the risks that warfarin may pose to the patient. The most important consideration is increased risk of bleeding, due to the way the drug works. As a result, patients taking warfarin may notice that they bruise more easily and all cuts usually take longer to stop bleeding. If the person is likely to suffer from bleeding, such as an elderly person who falls regularly, the risk of taking warfarin is greater.

Side effects:

The side effects of warfarin may include:
- Abdominal pain.
- To swell.
- Chills.
- Fever.
- Gastrointestinal bleeding.
- Headache.
- Long epistaxis.
- Nausea and vomiting.
- Changes of taste.

Drugs interactions:

Warfarin is known for the huge number of drugs it works with because it works in the liver where most drugs are metabolized.

It is wise to re-check the drug history of any patient who may be informed to begin treatment with warfarin, including over the counter products. Some plant medicines, such as St. John's wort, can also change the concentration of vitamin K in the blood and have a dramatic effect on bleeding and coagulation.

Additionally, some dietary sources may interact with warfarin, such as grapefruit and cranberry juice. Foods high in vitamin K like spinach can also affect clotting factors and the effect of warfarin.

Patient advice:

When a patient starts taking warfarin therapy, it is important that they receive the proper transmission about the effects of this medication.

Warfarin should be taken orally once a day at the same time, although with or without food it does not make a difference. It is important that the mark of the warfarin chosen to take remains the same as the effect of different brands may vary slightly. If a dose is missed, it should be taken as soon as the patient recalls, although two doses should never be taken together if not done until next day.

Frequent blood tests will be required, especially at the beginning of treatment to determine the correct dose of warfarin. The International Normal Report (INR) is used to measure clotting factors and dose efficiency.

Patients should be informed to continue eating a normal, healthy diet. Although foods affect the effectiveness of warfarin, if patients eat a consistent diet each week the dose will be adjusted to the patient's diet. Exceptionally high amounts of green vegetables or grapefruit can change how warfarin works.

When is INR too high for surgery?

A level of INR of 1.5 or below was considered suitable for surgery. A final PT and INR level was obtained for every patient on the morning of surgery. If the patient still had an increased INR (1.8 or above) after 3 days, vitamin K (oral preparation of 1–2.5 mg) was given.

How long does it take for warfarin to clear the body?

Coumadin (warfarin) will lose its effects at varying rates, depending on dietary factors, liver function, and other medicines that are being taken. If blood Coumadin levels are in the therapeutic range, in most people the effects are gone within 3-4 days of stopping the medicine.

What is normal range for INR?

In healthy people an INR of 1.1 or below is considered normal. An INR range of 2.0 to 3.0 is generally an effective therapeutic range for people taking warfarin for certain disorders. These disorders include atrial fibrillation or a blood clot in the leg or lung.

Do you stop warfarin if INR is high?

If your INR is higher than 10, you'll probably take vitamin K. You'll also want to stop taking warfarin and get frequent INR checks to make sure it's improving.

What is the INR range for warfarin?

The anticoagulant effect of warfarin should be kept at an international normalised ratio (INR) of about 2.5 (desirable range, 2.0-3.0), although a higher level may be better in a few clinical conditions.

What is the INR for surgery?

Before surgery, an INR of ≤ 1.5 is recommended. In many cases, the variability in decreasing INR over time warrants INR testing on the day before surgery. If it is elevated (usually > 1.8), there are data to suggest that the patient would benefit by receiving low-dose oral vitamin K (1-2.5 mg) for reversal.

What surgeries are high bleeding risk?

Procedures with high bleeding risk included intra‐abdominal surgery, intrathoracic surgery, intracranial surgery, orthopedic surgery, peripheral arterial surgery, urologic surgery, gynecologic surgery, otorhinolaryngologic surgery, other invasive procedures at deep lesions, and any other procedure lasting ≥1 hour.

What happens if you don t stop blood thinners before surgery?

But stopping an anticlotting drug is also risky. Doing so increases the chance of a blood clot, especially if you have surgery, which also leaves you more prone to a clot.

How do you have surgery if on blood thinners?

If the procedure carries a high bleeding risk, your healthcare team may decide to temporarily stop your blood thinner before the procedure. Compared to DOACs, warfarin has a longer half-life, meaning that the medication takes more time to leave your body. Typically, warfarin is stopped 3-5 days before a surgery.

Can you have emergency surgery while on blood thinners?

In patients exposed to oral anticoagulants (OACs) who require emergency surgery, the risks for bleeding, thromboembolism, and mortality are multifold higher than those in patients undergoing elective surgery 2. Anticoagulants can be discontinued in preparation for an elective procedure.

How long do you have to stop taking blood thinners before surgery?

They can be stopped 2-3 days before major surgery and held one day before minor surgery. These can be resumed the day after surgery if there is no bleeding.

What happens if you take warfarin before surgery?

Blood thinners can prevent blood clots from forming that can cause strokes. However, these drugs also can increase the risk of bleeding. Increased bleeding is especially a concern when someone is having a procedure or operation.

How many days do you hold warfarin before surgery?

For elective procedures, warfarin should be stopped for 5 to 6 days prior to the procedure to allow gradual normalization of the international normalized ratio (INR).