Can someone please explain INR & Coumadin therapy to me?

Nurses Medications

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I feel like this is my one big fuzzy area in nursing. I memorize what I do when I get a patient on Coumadin, and then I forget it until I have another pt. on it. Can you explain to me exactly what INR stands for and based on the numbers how you (well, the physician or NP) adjust Coumadin therapy? Thanks so much.

Warfarin (Coumadin) and INR ...

Fantastic! Very informative....thanks to you guys....love reading your ideas and knowledge.hope to read a lot from you all...thanks once again

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Before you sweat over a PT/PTT/INR, understand why the patient requires a blood thinning agent first. Long term bedrest, post-surgical, intermittent/chronic atrial fibrillation, intermittent claudication, genetic blood disorder. Understanding the need for the anticoagulant will lead you to the answer you seek. Communicate with the physicians: a surgeon, pulmonologist/cardiologist, oncologist are going to have different reasons, therefore, different parameters.

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Specializes in tried almost everything/LTC.

I've been a "coumadin cinic" nurse at a large cardiology practice, and loved it. (the pay was crap... but I digress.) Anticoag therapy is challenging, especially for patients. I agree with the info you've been given.

There is a mind boggling amount of info out there concerning this topic. our clinic was governed under the guidelines of the American College of Chest Physicians as far as target ranges and coumadin titration are concerned. Which is really pretty simple once you get the hang of it. -Managing your INR however is not. you can check out the ACCP website @ http://www.coumadin.bmscustomerconnect.com/ has interesting info.

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Specializes in RN in LTC.

I can't thank you all enough. I planned on spending this summer really understanding lab values and medication. The information here is wonderful.

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Specializes in Hospice, Med Surg, Long Term.

Several antibiotics also will either increase or decrease the INR.

Ex: Levaquin, Cipro, Sulfa drugs

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All this is really good info. A couple words of caution concerning anticoagulation...If a pt. falls while in the hospital, or is admitted due to a fall CHECK their meds to see if they are on any type of anticoagulant. Sounds simple, I know, but I see this being missed a lot. Do NOT give a dose of coumain to a pt who has been on the med for a while without an INR in front of your eyes. Take the extra 2 mins to look it up. If the pt has been on coumain for several days (or months) and no recent INR is available, get one before you give the med. I saw a nurse really dig her toes in with a dose of coumain one time and she saved her butt and the pt's big time. The pt had been on coumain at home for months for a-fib. She had been in the hosp about 5 days and no PT/INR had been drawn. The nurse saw this and approached the doc. He said the pt has been on the med for so long, no lab is needed. WRONG. So, she waited unitl 5pm when the on call doc took over, and called to get her labs drawn. The pt's INR was 28 and her PTT was 80 something. It was a miracle the woman wasn't bleeding out. The nurse took the extra time to follow up and it really paid off. Also, tell your pts going home on anticoagulation to be especially cautious against any trauma to their body. They need to be cautious of bumping their knee on the end table or even getting a paper cut. Sometimes pts don't connect that anticoagulation=easy brusining=potential to bleed a lot and need to be told outright.

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Angie O said:
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.

Wow,

Simple ,sweet and to the point. Love it. You should be a teacher... Thannnnnnnnnnnnnks...

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So, what kind of teaching to the techs/aides? No shaving even w/elec. razor? what else?

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Specializes in Long Term Care;.
Angie O said:
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

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Specializes in telemetry.

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

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Dear Angie,

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

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Yeah... me too! Thanks a lot!

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