[LTCPro]

Originally Posted by Angie O'Plasty, RN

It was easier for me to remember Coumadin this way:

Certain conditions or inactivity can cause clotting. Clotting is bad. Clotting makes DVTs, PEs, MIs and strokes. So basically anyone at risk for clotting needs some kind of anticoagulation therapy--SCDs, Lovenox, Heparin, and/or Coumadin.

Heparin and Lovenox work fast, so patients will be given those while in the hospital. Simultaneously, the doc will start them on Coumadin. The reason is that Coumadin takes a few days worth of doses to begin to be effective.

You check the INR. Most people have a normal INR of around 1.0. It's really not necessary to remember exactly what the letters stand for--I think it's International Normalized Ratio, so that wherever you go in the world, the numbers will be the same, so that everyone is on the same page when the numbers come in.

When the Coumadin kicks in, the INR should go up. The desired INR will vary for the condition being treated. A person who is an A-fibber will usually go home once the INR reaches around 2.2, but a person who had a heart valve replacement needs to be a little higher.

That is why the Coumadin is given at around 1800. It then has a chance to peak in the system when labs are drawn for the morning. You check the daily Prothrombin/INR labs to make sure that the patient is becoming therapeutic.

Then you'd check in the Dr.'s Progress notes to see what the plan is, and what number he's shooting for, because quite a few of these patients literally are stuck in the hospital till their INR numbers are right.

I hope that helps a little, and I'm sure others will be happy to contribute to this thread, because Coumadin/anticoagulation therapy is a Biggie drug, and everyone really needs to know it inside and out.

Excellent quick and dirty summary....As a long term care professional, the goal has been to keep the INR between 2 and 3 on a regular basis...many medications administered along with the coumadin can drive it up or down. You nailed it. I'd like to use your explanation to teach my staff...thank you

[fishchick72]

I just wanted to thank everyone for the great info in this thread.

[ROBERTF7]

Dear Angie,
As A New Nurse With Seven Months On A Busy Med/surg Floor This Helped Clear The Air.thank You

[newbornballer]

yeah... me too! thanks a lot!

[jack of trades!!]

all of the info was very helpful. I 'm glad I found this site.I now understand pt/inr better.

[WDWpixieRN]

Originally Posted by VickyRN

Here's a post I wrote in another thread:

WOW!! Do I wish you had been an instructor at our school!! What a fantastic explanation; I had looked through our texts and our med books and never found anything that outlines this as clearly and understandable as you have!!

[driveinstyle2005]

Can you please explain the normal values for ptt 20-45sec and pt 9.5-12sec

[Patti 2nd gen RN]

Our TCU does INR's 2X/week unless the patient isn't stable....please note different goals for different diagnoses...and we don't use algorthyms for INR's because of differing absorption levels---I have had patients who needed Vit K, but it took 3 days and 3 doses for their INR to come down, and others who respond in less than 24 hours...each patient and their meds and absorption rates need to be looked at individually...also, my facility gives coumadin at 9p...more important is patient education about what to watch for at home, and how thier diet affects their levels....