CVD - Warfarin Flashcards
Warfarin INR Target in VTE, AF, Cardioversion, MI, Cardiomyopathy?
INR of 2.5
Warfarin INR target in Recurrent VTE or Mechanical heart valve?
3.5
What is given in a minor bleed with INR 5-8 or over 8
Stop warfarin and IV Phytomeniadone
Minor bleed with warfarin usually means what?
Stop warfarin and START IV PHYTOMENIADONE
Major Bleed with warfarin?
IV a Phytomeniadone and Dried Prothrombin
INR OVER 8 with No bleeding?
Oral Phytomeniadone
INR 5-8 and no bleeding?
Withhold 1-2 doses of warfarin
Warfarin bleeding vs non bleeding how to remember?
Bleeding = ALWAYS IV PHYOMENIADONE IS INCLUDED
Non bleeding = Oral Phytomeniadone is max if not nothing
Warfarin monitoring regime?
1-2 days during early treatment
Then every 12 weeks after that
Warfarin MHRA side effects?
- SKIN NECROSIS & CALCIPHYLAXIS
- Haemmorhage (Vit k antidote)
What is CALCIPHYLAXIS?
Painful rash occurs due to build up of calcium
Warfarin In pregnancy?
Avoid in 1st & 3rd trimester
+ use contraception
What can increase INR levels?
Pomegranate
Cranberry
-
OTC miconazole
Tramadol
CYP450 inhibitors
PC-OTC
What can decrease INR LEVELS?
- Leafy greens (maintain - avoid changes)
- CYP450 Inducers decrease conc
Warfarin in minor surgery?
Perform if INR less than 2.5
Restart warfarin within 24hours
Severe bleed risk pt’s who take warfarin in surgery?
STOP warfarin 3-5 days before
If INR over or equal 1.5 Give Vit k day before
Warfarin patient who is at high risk of thromboembolism, what should occur?
First bridge with low MWT Heparin
Stop low mwt 24hrs before surgery
Restart Heparin low mwt 48hrs after
Warfarin Patient in need of emergency surgery? And it can be delayed 6 hrs?
(Eg car accident)
Give IV Vit K
Warfarin patient in need of emergency surgery? CANNOT be delayed!?
IV Vit K + Dried Prothrombin
(Same concept as major bleed)
