coumadin toxicity

[limabean]

What is the general rule for testing PT/INR levels on someone newly prescribed coumadin? My aunt went to her pcp recently and he did an ekg that showed afib with rvr. He started her on coumadin and toprol and sent her on home. He told her to come in 3 days later to check the pt/inr levels. Then she went almost 2 weeks before getting another level checked. He calls her at home tonight and tells her to go to the ER immed to get a vit K injection. I dont know yet what her INR level was but she said he sounded very stressed! I have been trying to tell her all week that this is not a benign drug that you dont have to worry about. We check pt/inr's daily on our pt's that first start taking it and then weekly for awhile....also it is adjusted constantly. I'm just wondering, am I overreacting or shouldn't you be tested more frequently? Not asking for medical advice ...just wanting to know what you all have found to be the accepted protocol for coumadin levels. Thanks.

[leslie :-D]

i've dealt w/doctors who had the pt/inr rechecked after 3 days; others have waited a week.

w/o knowing her levels, she should know the s/s of dangerously high levels:

loss of appetite, diarrhea, n&v, cramping, prolonged bleeding from benign cuts, persistent nosebleeds, easily bruised, dark urine, black stools, severe ha.

if the doctor sounded that stressed, i'm sure she should go to the er stat.

with peace,

leslie

[pagandeva2000, LPN]

What is the general rule for testing PT/INR levels on someone newly prescribed coumadin? My aunt went to her pcp recently and he did an ekg that showed afib with rvr. He started her on coumadin and toprol and sent her on home. He told her to come in 3 days later to check the pt/inr levels. Then she went almost 2 weeks before getting another level checked. He calls her at home tonight and tells her to go to the ER immed to get a vit K injection. I dont know yet what her INR level was but she said he sounded very stressed! I have been trying to tell her all week that this is not a benign drug that you dont have to worry about. We check pt/inr's daily on our pt's that first start taking it and then weekly for awhile....also it is adjusted constantly. I'm just wondering, am I overreacting or shouldn't you be tested more frequently? Not asking for medical advice ...just wanting to know what you all have found to be the accepted protocol for coumadin levels. Thanks.

I recently started working in a coumadin clinic, and the physician's assistant told me that it takes about three days before a certain dosage takes effect. Based on the PT/INR, he may have the patient come back within a week for those that are too low and if it is too high, he refers them to the emergency room. What my provider has done at the end of the day is tell them to go to the lab, get their blood drawn, and he will call them the next morning and advise them of what to do, and there are times where he would inform them to go to the emergency room immediately. Once, we had to send a woman STAT when her INR was an 8. Also, we tell them to bring in any medications or herbal supplements that the patient took, may it be of their personal choice, or prescribed by another physician for each visit. Garlic, ginsing, green tea, to name a few can alter the INR considerably. I usually ask them if they have taken anything not prescribed since their last visit, especially if after a regimen change and their INR is still rather low. I advise them not to walk barefoot, avoid contact sports, only shave with electric razors, not to wear shoes and socks that are too tight, to remove the skin off of cucumbers, etc...

[lhsouthern]

my mom is in the hospital after her inr was 13.0! she was on coumadin after being bed ridden after knee replacement and fusion of her right knee after getting mrsa in it. her dose was up to 7.5! you should see the bruising