INF/Warfarin

Question 1

What is INR

Answer 1

International normalised ratio. Normal is 1 but on warfarin it should be 2-3. People with an INR higher than 3 and not on warfarin may have a medical a condition

Question 2

What is warfarin

Answer 2

Vitamin k antagonist leading to a decrease in clotting factors

Question 3

Warfarin advice

Answer 3

Take same time every day as prescribed don’t double up if you miss a dose

Question 4

Intro

Answer 4

Do you know what INR/warfarin is?
Explain why they are in warfarin
INR too high explain
INR too low explain
What is the current impact on your sleep, social life, work, exercise and mood

Question 5

Presenting complaint

Answer 5

How are you feeling
Any recent infections or illness
Any high INR symptoms?
Any low INR symptoms?

Question 6

Symptoms of high INR

Answer 6

Headache, stomach ache, increased bruising, excessive bleeding, blood in urine

Question 7

Low INR symptoms

Answer 7

Sudden weakness/numbness/tingling in limb, visual changes, inability to speak

New pain, swelling, redness, heat in body parts or new SOB or chest pain

Question 8

PMHx

Answer 8

Liver failure, bleeding disorders (haemophilia or factor 7 def)

Question 9

DHx

Answer 9

Do you know how many times you’re taking warfarin?
How and when do you take it?
Are you finding it ok?
On any other medications?

Question 10

SHx

Answer 10

Ask about diet - any changes or more vit k food

Binge drinking

Smoking

Question 11

Advice

Answer 11

Decreased risk of bleeding
Avoid activities that can cause bleeding and bruising
Brush and shave gently
Tell dentist you take anticoags

Question 12

How to treat high INR

Answer 12

Vitamin K
Blood components
Decrease warfarin dose

Question 13

How to treat low INR

Answer 13

LMWH, warfarin
Compression stockings