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Bridging Anticoagulants – Warfarin

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A quick description of how to bridge warfarin with LMWH

All right welcome to another episode of farmed eme my name is ty and today we’re talking about bridging anticoagulants the the purpose of bridging anticoagulants is when a patient’s on warfarin and they need to have a procedure done and in order to make sure that they don’t bleed too much during the procedure they want to have the patient on a drug with a short

Half-life that they can stop immediately before the procedure perform the procedure and then immediately get them started again to make sure that their inr doesn’t get too low so what we have here is a little protocol that i put together that will help kind of organize your thoughts when you’re thinking about bridging anticoagulants so the first thing is we’re

Gonna stop the warfarin five days before the scheduled surgery and some things about warfarin is its full therapeutic effect takes about five to seven days and it’ll take about two to three days once you stop warfarin before the inr will drop below two which is considered an acceptable level in terms of starting the low molecular weight heparin which is what we’re

Going to use to bridge so about five days before the scheduled start surgery we’re gonna stop the warfarin if at high risk for thromboembolism we’re going to start the low molecular weight heparin three days before the surgery or when the inr drops below two and then 24 hours before the surgery we’re gonna stop the low molecular weight heparin you can also use

Unfractionated heparin but i think most hospitals use low molecular weight heparin before surgery and then we’re gonna perform the surgery and then we’ll restart the low molecular weight heparin within 48 to 72 hours after hemostasis has occurred for major surgery will start restart in about 24 hours after hemostasis has occurred for minor surgeries you know i’ve

Put a couple stars around this one if you restart too soon you can increase the risk of bleeding if you wait too long the inr may not be therapeutic for the patient we’re gonna actually restart the warfarin in about 12 to 24 hours post-surgery but again it takes about five to seven days for warfarin to reach its full therapeutic effect once the inr has reached the

Appropriate level for the patient it could be anywhere from two to three if it’s a mechanical heart valve it might be a little bit higher than that that’s when we can discontinue the heparin product i put a couple alternatives down here if a patient has a history of head you can use our contraband i believe that the desi rudin is a popular product and then i put

Another little star here just just show that unfractionated heparin to bridge patient with stage five kidney disease i did want to take a couple of minutes here to talk about warfarin itself so it’s indicated for thrombo embolic complications stemming from a fib or valve replacement and it’s also indicated after myocardial infarctions some common things that you

Want to make sure your patients know and they’re taking warfarin is that it can lead to bleeding and you also want to make sure that the patient knows about the diet patients taking warfarin need to have a steady amount of vitamin k in their diet so it’s okay if they eat a salad or a bowl of spinach but they just need to make sure that they you know kind of stay

Steady they don’t eat too much salad one week and then not enough the next week because it will mess with their inr readings and their ability to anticoagulate it is a pregnancy category x there is a couple cases where it’s pregnancy category d but for the most part is category x but it is okay in breastfeeding in terms of drug interactions there’s a slew of drug

Interactions probably just you know one thing to kind of focus on would be that it’s a cytochrome p450

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Bridging Anticoagulants – Warfarin By PharmD\u0026ME