pharmacist

⭐Test your knowledge and check your answers on the second slide!

Let’s talk warfarin INR goals 🤓⁠
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💊 Warfarin is a vitamin K antagonist that requires INR (international normalized ratio) monitoring due to its narrow therapeutic index. Dosing is affected by many factors including diet, drug interactions, genetics, and close INR monitoring is required to decrease the risks of bleeding and/or clotting.⁠
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🤔 Overall, direct oral anticoagulants (DOACs) are now recommended over warfarin in the majority of clinical situations unless there is a compelling reason for them to on warfarin such as valvular atrial fibrillation, severe renal dysfunction, patient costs, or close therapeutic anticoagulation monitoring required.⁠
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🔑 Key points about INR monitoring:⁠
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-Baseline INRs are recommended prior to initiating warfarin therapy⁠
-Warfarin requires overlap or ‘bridging’ with heparin or LMWH for 5 days and until INR is within goal for 24 hours (TIP: warFARin takes a long time to achieve full anticoagulation so think FAR into the future compared to other anticoagulants)⁠
-Changes in the INR is typically seen 2-3 days after administration of the dose (TIP: a physician I use to work with always said Jesus rose on the 3rd day and so will your INR 😅)⁠
-Prior to making a dose adjustment, assess for any missed doses, drug interactions, dietary intake or supplements, documentation of bleeding, or other changes that can affect the INR⁠
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How many of the INR goals did you get correct? TIP is to memorize the outlier – the majority of the time, the INR goal is 2-3 except in high-risk patients such as those with mechanical valve replacements in the MITRAL position (goal is higher 2.5-3.5)⁠
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