Warfarin Guidelines

Question 1

Where could you find information about warfarin in the BNF?

Answer 1

Search for “oral anticoagulants treatment summary” or search for phytomenadione to get indications for giving vitamin K (will give you INR/ if bleeding etc)

Question 2

Actions if someone has warfarin and major bleeding?

Answer 2

stop warfarin, give phytomenadione (vitamin K), and prothrombin complex

Question 3

Action if INR > 8 minor/ no bleeding?

Answer 3

stop warfarin, give phytomenadione (vitamin K), repeat vitamin K if still high > 24 hours, restart warfarin when INR < 5

Question 4

Action if INR 5-8 and minor bleeding?

Answer 4

stop warfarin, give phytomenadione (vitamin K) and restart warfarin when INR < 5

Question 5

Action if INR 5-8 and no bleeding?

Answer 5

withhold 1-2 doses of warfarin and reduce subsequent maintenance dose

Question 6

If a patient is undergoing emergency surgery and on warfarin an INR > 1.5?

Answer 6

need to give prothrombin complex, vitamin K will not work quickly enough if going in for emergency surgery that day

Question 7

When can you not give DOACS?

Answer 7

in pregnancy (give LMWH instead)
in renal failure (usually give unfractionated heparin instead)

Question 8

If someone has a stroke and AF, when do you start DOACs?

Answer 8

2 weeks post the stroke event