If people are on coumadin for chronic health problems such as stroke or afib like Angie said, then they will most likely go into their family clinic to have their INR's checked every couple of weeks or monthly or so. While people are in the hospital, they usually have daily INR's. Sometimes the protocol tells us to call the physician for the amount. The computer pulls the daily INR lab results and determines what amount we should give at 1800. Where I work now, we have a computerized protocol. For example, if daily INR was 1.0, then give 5 mg Coumadin. When I worked in a subacute nsg home, we had a paper printout, much just an insulin sliding scale. In some facilities you will see a protocol or sliding scale to determine the daily Coumadin/warfarin dose. Also I believe each medication affects a different end of the coagulation cascade (remember that from phys class?). Wow, excellent reply Angie O'Plasty! That's a good explanation about heparin acting faster and Coumadin slower. 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. 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. You check the daily Prothrombin/INR labs to make sure that the patient is becoming therapeutic. It then has a chance to peak in the system when labs are drawn for the morning.

That is why the Coumadin is given at around 1800. 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. The desired INR will vary for the condition being treated. When the Coumadin kicks in, the INR should go up. 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. Most people have a normal INR of around 1.0. The reason is that Coumadin takes a few days worth of doses to begin to be effective. Simultaneously, the doc will start them on Coumadin.

Heparin and Lovenox work fast, so patients will be given those while in the hospital. So basically anyone at risk for clotting needs some kind of anticoagulation therapy-SCDs, Lovenox, Heparin, and/or Coumadin. Clotting makes DVTs, PEs, MIs and strokes. It was easier for me to remember Coumadin this way:Ĭertain conditions or inactivity can cause clotting.

Inr antidote