Coumadin question

ChristineN, BSN, RN · May 18, 2009

Correct me if I'm wrong, but I would think it would be much more important to continuing giving Coumadin at the same time the pt took at home in order to keep the levels the same. Makes more sense than having all pts on the same schedule, when the pt is just going to adjust the schedule to their needs as soon as they get dc'ed anyway.

Be_Moore · May 18, 2009

Taking Coumadin in the evening / at night has a definite benefit. When you draw a PT in the AM, you are sure to have the lab results back prior to administration of the medication, should you need to hold the dose. If you were to give it at 5AM, you may have already administered the medication before finding out that a patient's PT is extremely elevated. Most people are told as outpatients to take the coumadin in the evening/at night because they recieve lab results at coumadin clinics a bit slower than we do inpatient. That way they can call the patients and tell them not to take the dose, should they need to. Because of this, most facilities (that I am aware of) also schedule coumadin for PM dosing.

RNKPCE · May 18, 2009

Most of my patients also take their coumadin in the evening at home probably for the above reasons.

StNeotser, ASN, RN · May 18, 2009

We do it in the evening because of the timing of when the labs are drawn. We normally get labs back around 11am to 2pm and the coumadin is given at 5-6pm. Gives us time to get an order to change or hold the coumadin.

Magsulfate, BSN, RN · May 18, 2009

Yes, it is so that we have the lab results back before the dose is given... .

Reno1978, BSN, RN · May 18, 2009

We give it at 1800 where I work. Besides ensuring that it is given after lab results are back, patients are less likely to eat foods that interfere with its effectiveness in the evening/night hours.

pagandeva2000, LPN · May 18, 2009

Taking Coumadin in the evening / at night has a definite benefit. When you draw a PT in the AM, you are sure to have the lab results back prior to administration of the medication, should you need to hold the dose. If you were to give it at 5AM, you may have already administered the medication before finding out that a patient's PT is extremely elevated. Most people are told as outpatients to take the coumadin in the evening/at night because they recieve lab results at coumadin clinics a bit slower than we do inpatient. That way they can call the patients and tell them not to take the dose, should they need to. Because of this, most facilities (that I am aware of) also schedule coumadin for PM dosing.

This is an excellent explanation to why this is done. I never heard it explained so nicely before. Greatly appreciated...from an LPN who does work the Coumadin Clinic occasionally!

LHH1996 · May 18, 2009

we give around 1800 so that when lab results come before that..you can adjust the dose (or hold if needed)

Daytonite, BSN, RN · May 19, 2009

Because the onset of action for Coumadin is longer (12 hours), the effects of the dose the patient takes in the evening isn't going to register in their labwork until the following morning. The lab wants to draw the PT a certain number of hours after the last dose of Coumadin and most hospital labs want to draw blood in the early morning.

starletRN · May 19, 2009

Thank you for your replies. I'm a new nurse and I had to write in the time for a pt's first Coumadin dose. I timed it with some other nightly meds she would be getting but the nurse I reported off to said it had to be given earlier than that.

It was caught in time, but I like to know the rationale behind things so it sticks in my memory banks better for next time.