This might be a stupid question (because I feel like I should know the answer) but I am going to ask it anyways..
My patient came in with a high INR so her Coumadin was stopped. She was started on Heparin subq every 8 hours. She asked me what Heparin was and I explained it to her, she then asked why she could be on Heparin but not the Coumadin. Now this is my question, did I answer her correctly when I stated that she needed to be on some kind of blood thinner (hx of recent PE) and since Heparin was short acting it was the best choice?
Why was the patient admitted to hospital? The thing is, if the patient was already on warfarin (with therapeutic INR) AND developed a VTE, the treatment is still UH/LMWH. However, if the INR is supratherapeutic, then you will stop the warfarin (or at least decrease the dose) and allow the INR to return to the target range, but you will still need to give UH/LMWH to treat the VTE.
Also, the reason you bridge warfarin with UH/LMWH is that warfarin is a (paradoxically) procoagulant initially (as it inhibits protein c synthesis), and the bridging is there to prevent clots while awaiting the inhibition of procoagulant factor synthesis.
Last edit by fermium on Jun 8, '13