Warfarin Mastery: Dosing Adjustments, Reversal Protocols, and Perioperative Bridging
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Warfarin Mastery: Dosing Adjustments, Reversal Protocols, and Perioperative Bridging
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Episode 3 is the essential practical guide to managing patients on Warfarin (Coumadin). We demystify the complex protocols with a focus on clinical decision-making.
Inside This Episode:
INR Management Made Easy: We provide a detailed table of actions for various International Normalized Ratio (INR) ranges, offering precise instructions on when to adjust, hold, or resume dosing, and the timing for follow-up INR checks.
Reversal Strategies: A clear, step-by-step protocol for warfarin reversal, differentiating between non-emergent INR elevation and life-threatening bleeding emergencies.
Memory Aids & Pitfalls: Essential mnemonics and guides to help clinicians instantly recall the major factors that influence INR (including antibiotics, diet, alcohol, and herbal supplements).
The Bridge Protocol: A comprehensive section on perioperative warfarin management, including when to stop the medication before surgery and clear criteria for initiating Low Molecular Weight Heparin (LMWH) bridging therapy based on patient risk stratification (e.g., using the CHADS_2 score).