INR Flashcards
Normal INR
1.0
Normal for anticoagulant
2-3
INR results higher than 3.0 may put you at even higher risk for bleeding. INR results lower than 2.0 may put you at risk for developing a blood clot.
SE warfarin
periods that are heavier and last longer than usual
bleeding for a little longer than usual if you cut yourself
occasional nosebleeds (that last for less than 10 minutes)
bleeding from your gums when you brush your teeth
bruises that come up more easily and take longer to fade than usual
Prevent bleeding
avoid playing contact sports or other activities that can cause an injury, such as football, rugby, hockey and horse riding
wear gloves when you use sharp objects like scissors, knives and gardening tools
stop wet shaving or removing hair with wax – use an electric razor or hair-removing cream instead
take false teeth (dentures) or retainers out for a few hours a day, if you wear them, to give your gums a rest – do not wear dentures or retainers that do not fit properly
tell your doctor, dentist or nurse that you take warfarin before you have any medical or dental procedures or surgery – this includes vaccinations and routine appointments with the dental hygienist
Symptoms of bleeding in brain
a very severe headache
seizures or fits
sudden loss of vision or blurred vision
numbness or tingling in your arms or legs
Symptoms of serious bleefing
you get nosebleeds that you cannot stop and that last longer than 10 minutes
you have blood in your vomit or you’re coughing up blood
you get severe headaches
you have any bleeding from a cut or injury that will not stop or slow down
Foods that affect warfarin
green leafy vegetables, including broccoli, spinach and lettuce
chickpeas
liver
egg yolks
mature cheese and blue cheese
avocado
olive oil
It’s important that you eat foods containing vitamin K, so rather than leaving them out of your diet, make sure you eat similar amounts of them regularly.
This will mean the level of vitamin K in your blood stays fairly constant and makes it more likely that your INR level stays stable.
Do not drink cranberry or grapefruit juice while you’re taking warfarin. It can increase the effect of your medicine and put you at higher risk of bleeding.
Warfarin and pregnancy
Warfarin is not recommended during pregnancy as it can sometimes cause birth defects and bleeding problems for the baby.
There’s no evidence to suggest that taking warfarin reduces fertility in either men or women.
Speak to your doctor if you’re trying to get pregnant. Because warfarin is not recommend in pregnancy they will want to review your medicine.
Warfarin gets into breast milk in tiny amounts, and it is unlikely to cause side effects in your baby.
Talk to your health visitor, midwife, pharmacist or doctor as soon as possible if:
your baby is not feeding as well as usual
your baby seems to bleed or bruise easily
you have any other concerns about your baby
How to take warfarin
The usual warfarin dose for adults is 10mg a day for the first 2 days, then between 3mg and 9mg a day after that.
The usual warfarin dose for children depends on how much they weigh.
Warfarin tablets come in 4 different strengths. The tablets and the boxes they come in are different colours to make it easier for you to take the right dose.
The strengths and colours are:
0.5mg – white tablet
1mg – brown tablet
3mg – blue tablet
5mg – pink tablet
Your dose may be made up of a combination of different coloured tablets.
Warfarin also comes as a liquid, where 1ml is equal to a 1mg (brown) tablet.
Warfarin liquid comes with a plastic syringe to help you measure the right amount.
How to take warfarin
You’ll usually take warfarin once a day in the evening. Take it at around the same time each day. This is so that if you need to change the dose after a routine blood test, you can do this the same day rather than waiting until the following morning.
Warfarin does not usually upset your stomach, so you can take it with or without food.
BT and warfarin
You’ll have a test every 1 or 2 days when you first start taking warfarin, then once or twice a week, until your ratio is stable at the target level.
Once your blood test results are stable, you might only need a blood test up to once every 12 weeks. You might need blood tests more often than normal if you start other new medicines, or when you are ill.
What does warfarin do
Vitamin K antagonist (blocks vitamin K epoxide reductase) leading to decrease in
factors 2, 7, 9 and 10.
Patient friendly warfarin explanation
Warfarin is an anticoagulant and that means its job is to stop the blood from clotting too easily.
Provides information about someone’s bloods tendency to clot.
o The higher the INR, the longer it takes the blood to clot and so the increased
bleeding risk. The lower the INR, the thicker the blood so increased clotting
risk.
Commonly used to treat blood clots (DVT/PE/prevent stroke in AF).
How to keep up to date with patient on warfarin
Ask how they are feeling?
- Any recent infections/illnesses?
- Any diarrhoea/vomiting?
o Bloody/dark stool or vomit. - Any high INR symptoms?
- Any low INR symptoms?
High INR symptoms
Headache, severe stomach ache.
o Increased bruising.
o Prolonged bleeding after minor cuts/menstrual bleeding/gum bleeding. o Blood in urine.
