CVD - Warfarin

Question 1

Warfarin INR Target in VTE, AF, Cardioversion, MI, Cardiomyopathy?

Answer 1

INR of 2.5

Question 2

Warfarin INR target in Recurrent VTE or Mechanical heart valve?

Answer 2

3.5

Question 3

What is given in a minor bleed with INR 5-8 or over 8

Answer 3

Stop warfarin and IV Phytomeniadone

Question 4

Minor bleed with warfarin usually means what?

Answer 4

Stop warfarin and START IV PHYTOMENIADONE

Question 5

Major Bleed with warfarin?

Answer 5

IV a Phytomeniadone and Dried Prothrombin

Question 6

INR OVER 8 with No bleeding?

Answer 6

Oral Phytomeniadone

Question 7

INR 5-8 and no bleeding?

Answer 7

Withhold 1-2 doses of warfarin

Question 8

Warfarin bleeding vs non bleeding how to remember?

Answer 8

Bleeding = ALWAYS IV PHYOMENIADONE IS INCLUDED

Non bleeding = Oral Phytomeniadone is max if not nothing

Question 9

Warfarin monitoring regime?

Answer 9

1-2 days during early treatment
Then every 12 weeks after that

Question 10

Warfarin MHRA side effects?

Answer 10

• SKIN NECROSIS & CALCIPHYLAXIS
• Haemmorhage (Vit k antidote)

Question 11

What is CALCIPHYLAXIS?

Answer 11

Painful rash occurs due to build up of calcium

Question 12

Warfarin In pregnancy?

Answer 12

Avoid in 1st & 3rd trimester

+ use contraception

Question 13

What can increase INR levels?

Answer 13

Pomegranate
Cranberry
-
OTC miconazole
Tramadol
CYP450 inhibitors

PC-OTC

Question 14

What can decrease INR LEVELS?

Answer 14

• Leafy greens (maintain - avoid changes)
• CYP450 Inducers decrease conc

Question 15

Warfarin in minor surgery?

Answer 15

Perform if INR less than 2.5

Restart warfarin within 24hours

Question 16

Severe bleed risk pt’s who take warfarin in surgery?

Answer 16

STOP warfarin 3-5 days before

If INR over or equal 1.5 Give Vit k day before

Question 17

Warfarin patient who is at high risk of thromboembolism, what should occur?

Answer 17

First bridge with low MWT Heparin

Stop low mwt 24hrs before surgery

Restart Heparin low mwt 48hrs after

Question 18

Warfarin Patient in need of emergency surgery? And it can be delayed 6 hrs?
(Eg car accident)

Answer 18

Give IV Vit K

Question 19

Warfarin patient in need of emergency surgery? CANNOT be delayed!?

Answer 19

IV Vit K + Dried Prothrombin

(Same concept as major bleed)