Warfarin
What is warfarin
Warfarin is an anticoagulant with therapeutic indications for coronary occlusion; deep vein thrombosis; pulmonary embolism; peripheral vascular thromboembolic states; mesenteric and retinal thromboembolism (Medsafe, n.d.).
Prothrombin Time test (PT) and International normalised ratio (INR)
Results are usually calculated in seconds, or as a ratio known as INR.
Interactions
There are many medications that do not interact well with warfarin and can cause an increase in a persons INR. These can include some anti-fungal's, antibiotics, aspirin, acetaminophen laxatives and more. It is important that the doctor is made aware of what medication a person is taking prior to being prescribed warfarin (McKenna & Lim, 2014).
Risk factors
Bleeding, blood in urine and stools, dizziness or weakness, severe bleeding such as a heavier menstrual period, severe headache or stomach pain, vision changes and head injury even if there is no bleeding (Medsafe, n.d.).
When taking warfarin, PT (measured as INR), will be checked every day until it is in the correct range. Once it is stable, the INR will be taken less often, such as every 2-3 weeks. After this, if it is stable it will be taken every 4-6 weeks (Health Navigator, 2020).
Prothrombin time measured as a ratio- INR. Because the results from the PT test vary from laboratory to laboratory, a INR is calculated. Calcculating it in this formula allows for differences in different laboratories so that the test results can be compared. In most cases the ideal target INR is between 2-3 but for some people at high risk of developing a blood clot the target needs to be higher - 2.5-3.5. If the INR is above target range, it means the blood is clotting too slow, which places a person at risk of bleeding. If it is lower than the target range, it means the blood is clotting quickly, putting the person at risk of developing unwanted clots (Health Navigator, 2020).
The PT test and INR test are both blood tests that measures how long it takes for the blood to clot. It is used to check blood disorders and to monitor blood thinning medications (Health Navigator, 2020).
Prothrombin time in seconds. Prothrombin is usually measured in seconds. It is the time it takes for your blood to clot. The results of the test vary depending on a number of factors. It depends on the laboratory, the test chemicals used in the different laboratories and the method that is used to test the blood (Health Navigator, 2020)
Contraindications.
Those who have major surgery within the past 72 hours, are pregnant (1st and 3rd trimester), have had a hemorrhagic bleed, have hypersensitivity to warfarin or who have had a major clinical bleed, should not take warfarin (McKenna & Lim, 2014)
Pharmacology
Warfarin acts by meddling with the normal coagulating course and the thrombin arrangement. It causes a reduction in the creation of nutrient K subordinate coagulating factors in the liver. This in the end prompts the exhaustion of these thickening components and prolongation of coagulating times.
It is absorbed from the GI tract, metabolised in the liver and excreted in the urine. Warfarin has a half life of around 40 hours and the time it takes to reach peak plasma concentration is around 24-48 hours (McKenna & Lim, 2014)
References: Health Navigator. (2020). Prothrombin time (PT) & INR.https://www.healthnavigator.org.nz/health-a-z/p/prothrombin-time-pt-test-inr/#:~:text=At%20first%20prothrombin%20time%20(measured,to%20every%204%E2%80%938%20weeks.
Medsafe. (n.d.). Datasheet: Marevan tablet. https://www.medsafe.govt.nz/profs/Datasheet/m/Marevantab.pdf
McKenna, L., & Lim, G. (2014). McKenna's Pharmacology for Nursing and Health Professionals.Wolters Kluwer