Has Anyone Here Worked in a Coumadin Clinic?

  1. If so, what is it like? I received a potential job offer yesterday to work in the Coumadin clinic of a large, outpatient cardiology practice. I have several years of experience working Med/Surg inpatient nursing, as well as a year of hospice nursing and several months of LTC nursing. Needless to say, I have given a ton of Coumadin and Lovenox over the years and am very familiar with the concept of PT/INR testing. However, I have never had to draw an INR level, dose Coumadin, or design a bridge protocol between Coumadin and Lovenox. I have simply checked the lab value and called the physician for orders. The job sounds pretty simple and straightforward, but I'm a little apprehensive about not having worked in an anticoagulant clinic before.

    Can anyone offer any information or advice? It would be much appreciated!
  2. Visit westieluv profile page

    About westieluv

    Joined: Jul '10; Posts: 951; Likes: 2,189
    RN; from US
    Specialty: 26 year(s) of experience in Med/Surg, Tele, Dialysis, Hospice


  3. by   jeffsher
    One consideration: how long will coumarin clinics be needed, as the new drug Pradaxa doesn't require lab work?
  4. by   westieluv
    So how does Pradaxa work that you don't need to check the PT/INR regularly? It seems like an anticoagulant has to be monitored somehow. How would you know if it was therapeutic?
  5. by   jeffsher
    Pradaxa is a direct thrombin inhibitor, while Coumadin/Wafarin prevents the activation of*4 clotting factors that depend on*Vitamin K. No need for monthly labs and frequent dose adjustments as with Coumadin. Of course, time will tell whether Pradaxa will replace Coumadin in A-fib patients....
  6. by   A&OxNone
    I have worked in part of a coumadin clinic before PRN in a medical clinic i used to work for. It was pretty straight forward. Lots of patient education about diet and the medication process and such. I really enjoyed it. We did fingerstick PT/INR so you get a result in about 30 seconds. Good luck!
  7. by   westieluv
    Thanks to all of you for your replies. I actually didn't end up taking the position in the coumadin clinic because I was offered a Med/Surg float job in a hospital that is much closer to my home and pays more. I think that the coumadin clinic job sounded interesting, I wish it would have worked out.
  8. by   WALKIETALKIE11
    FROM WHAT i HAVE READ, PRADAXA IS FOR ATRIAL FIBRILLATION USE ONLY OF PREVENTION OF BLOOD CLOTS. However, pradaxa has not been approved by FDA for patients that ALREADY have blood clots- ex: DVT, PE. And there are labs to monitor it, but they are a little more expensive- ECT. However, with it being a fairly new drug some MD's are skeptical because it simply hasn't been out long enough. With coumadin you have a set therapeutic levels. I have also read that hemorragging can't be reversed with pradaxa while coumadin is fixed with vitamin k......however, from the lips a cardiologist- hemorragging is less likely with pradaxa....
  9. by   CCL RN
    Coumadin is on it's way out. Yes, pradaxa is only approved for A-fib; right now. It's new, give it time. No testing, no food interactions, no constant dose adjustments...
  10. by   GoodNP
    Quote from CCL RN
    Coumadin is on it's way out. Yes, pradaxa is only approved for A-fib; right now. It's new, give it time. No testing, no food interactions, no constant dose adjustments...
    Warfarin is definitely less attractive next to pradaxa and the other soon-to-hit-the market options such as apixiban and edoxaban. These drugs however are not good options for the renal insufficient. So until this is overcome, warfarin will still be around.

    Also, Pradaxa is already indicated for DVTs in Europe, and is expected to get FDA approval in fourth quarter this year.
  11. by   jeffsher
    Just had an inservice on Pradaxa this week. It's not good for those with risk of GI bleed, but it carries lower risk of intracranial hemorrhage. Coumadin has a narrow therapeutic index, which is a definite disadvantage, but it's proven therapy. As mentioned, it's not good for those with creatinine clearance of below 30 (?), and it does not have an "antidote" like heparin and coumadin. There are studies that it possibly can be dialyzed out. However, it's duration of action is through the next daily dose, whereas coumadin exerts it's effects longer. If you miss 2-3 days of coumadin, no big deal; it is a big deal if you miss a dose of Pradaxa.

    Other disadvantages of Pradaxa: cost, it must be stored in it's original bottle or package, and if bottled, is only good for 60 days (although the directions currently indicate 30 days).

    I think that once it's indicated for more conditions, Coumadin will take a back seat to Pradaxa, but that isn't anytime soon.
  12. by   ghillbert
    There are other drugs that are better than pradaxa, and it has just been approved for limited indication. Let's wait and see what the post market approval results are like before we all jump off the coumadin bandwagon... pradaxa has several problems in certain populations, particularly those at risk of surgical complications, because it's not immediately reversible like coumadin or heparin. As mentioned, the cost and expiration are other considerations (and not insignificant ones - drugs don't work if patients can't afford to take them, no matter how good they are).

    I haven't worked in a coumadin clinic but I do have to adjust dosing regularly in my patients, it's very interesting to see how patient-specific the doses and dose changes are. The job has a LOT of patient education required with regard to medication as well as diet, recognizing problems, when to call in etc.

    I think the patients that require a/c longterm will still be managed by the a/c clinic, even if they are switched to a newer med. It is exciting to see the new drugs finally reaching market approval status. It's a good bet for the pharm company - lifelong treatment of a gazillion people with a/coagulation.. $$$

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