Warfarin and lovenox

[usRNs]

Hello everyone I hope you guys can help.... At work I had a patient who was both on lovenox and warfarin... I held warfarin because the patient was bleeding "not profusely" it was dark red from her trach having a quarter of the canister filled and there was some on the foley as well... My thought was the patient is bleeding and though is not profusely if I give the warfarin which will remain 3-5 days in the system he will probably reach therapeutic INR level (it was 1.4) and I didn't want her to bleed much more, i administered the lovenox because my thought was well at least she will be anticougulated until the morning without lowering the INR so much, it only remains in the body 24-36hours and in the morning the primary can decide...I work at night so I was a little hesitant on calling the doctor for it... "My question is was my though process wrong?" I was told that I should have not held it because this two meds have two different pathways, I'm not sure on the pathways but I know they both increase INR. As I'm writing this post I realize more and more the things I could of done and the reason why, but I would like to hear from you. Tnx

[ckh23, BSN, RN]

I think a call to the doc would have been warranted because of the continued bleeding. You should also review your coag pathway because each med works on the different pathways and Lovenox will not effect your INR because it works on the intrinsic pathway just like heparin. What was the pt being anticoagulated for?

[nrsang97, BSN, RN]

I would have held off on giving both until hearing from the MD.

[KelRN215, BSN, RN]

Lovenox is low molecular weight heparin. It, like heparin, does not affect the INR. Heparin affects the PTT. When I worked in the hospital, we checked drug levels on lovenox patients. I would have called the MD.

[applewhitern, BSN, RN]

I can see a little bit of bleeding if it was a new trach, or if aggressive suctioning was done. However, blood on the foley as well? A quarter of a canister? Yes, I would have called the doc.

[applewhitern, BSN, RN]

In my state, withholding a med without a doctor's order is the same thing as practicing medicine without a license. I know, I know. But until you are absolutely sure of your "thought processes," you should call the doctor.

[evolvingrn, BSN, RN]

you were wrong they are giving the lovenox to keep her blood 'thin' until they get her coumadin to a therapeutic level (which at 1.4 they aren't there) so that really isn't your call to make to hold coumadin, that should be make an MD/PA/NP. and regardless lovenox would have been the one to hold for active bleeding but you should have called a dr and had them make that decision. Also Coumadin is usually given at 5 pm, so the MD should have been there? why are they giving that at night?