Generic: warfarin Clients dose: Administration time:

ROUTE ONSET PEAK DURATION PO,IV 36-72 hr 5-7 days 2-5 days Route/Normal Dose Range: PO, IV 2-5 mg/day for 2-4 days; then adjust daily dose by results of INR. Initiate therapy with lower doses in geriatric or debilitated pts or in Asian pts Contraindications: Uncontrolled bleeding, open wounds, active ulcer disease; recent brain, eye, or spinal cord injury or surgery; severe liver or kidney disease; uncontrolled hypertention. Use cautiously in: Malignancy; pts with hx of ulcer or liver disease; hx of poor compliance.

Brand Name: Coumadin Therap. Class: anticoagulants Pharm Class: coumarins Adverse Reactions/Side Effects: GI: cramps, nausea. Derm: dermal necrosis. Hemat: bleeding Misc: fever.

Evaluation/Desired Outcomes: Prolonged PT (1.3-2.0 times the control; may vary with indications) or INR of 2-4.5 without signs of hemorrhage.

Action: Interferes with hepatic synthesis of vitamin k-dependent clotting factors(II VII IX and X) Indications/Therapeutic Effect: Prophylaxis and treatment of: Venous thrombosis, Pulmonary embolism, Atrial fibrillation with embolization/ Prevention of thromboembolic events.

Nursing Implications / Assessment: Assess for sign of bleeding and hemorrhage (bleeding gums; nosebleed, unusual bruising; tarry, black stools; hematuria; fall in hematocrit or blood pressure; guaiac-postive stools, urine, or nasogastric aspirate). Assess for evidence of additional or increased thrombosis, Symptoms depend on area of involvement. GERi: Patients over 60 yr exibit greater than expected PT/INR response. Monitor for side effects at lower therapeutic ranges.