Quote from HHRN22
We draw serum PT/INR levels for patients in injectables per MD orders. But when they are done with the injectables and will solely be on the Coumadin, that's what we are trying to come up with a protocol for our agency as to when our nurses should do a venipuncture or use a portable when our patients have finished the last dose of their injectable(either concurrent with PO Coumadin or with just the injectables alone) so MDs know whether to extend the injectables or not.(homehealth setting ,btw)
We have been waiting 5-7hrs after the last dose of the injectable before we draw their PT/INR level via portable unit. But I was just wondering if there were any other protocols/parameters out there that I didn't know about.
Glad to know we've been doing it right waiting 5-7hrs(given that halflife is 4.5hrs for lovenox)!
Thanks again for the reply!
Okay but I think what I'm saying is that the INR is measured to determine the effectiveness of warfarin therapy, not the effectiveness of Lovenox therapy and it doesn't matter whether it's done by venous sample sent to the lab or by fingerstick at home, it's still only measuring the INR.
If the patient has been discharged on both warfarin and Lovenox, they usually stay on Lovenox until their INR is in the target range so you'd need to check the INR dependent of the timing of the last dose of warfarin, not the last dose of Lovenox.
If they've just finished their Lovenox and are on warfarin only, I really don't think you need to wait any particular time after the last dose of Lovenox. The warfarin dose will be adjusted according to the INR and when the last dose of warfarin was taken.
There's lots of good information out there on warfarin therapy, your local pathology company would probably be able to help you. Maybe the doctor wants samples sent to the lab during this transition period because the fingerstick INR may not be as accurate?
I have a feeling I'm still not answering your question.