Hold your warfarin (coumadin) for one day

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Reference no: EM133785734

Question: A patient presents for follow-up of her warfarin (Coumadin) management. She is currently taking warfarin (Coumadin) 5 mg oral daily for atrial fibrillation. Her goal therapeutic INR is 2.0-3.0. She denies bleeding. When asked about medication changes, she reports that three days ago, she went to an urgent care. She was started on clarithromycin (Biaxin) (a strong CYP3A4 inhibitor) for 10 days for a sinus infection. Her INR comes back today at 4.8. You are contacting her by phone to follow-up on this abnormality. What advice do you give her? Hold your warfarin (Coumadin) tonight. Check the INR tomorrow. Hold your warfarin (Coumadin) for one day and decrease your dose to 4 mg daily while on clarithromycin (Biaxin). Repeat INR in 5-7 days. Hold your warfarin (Coumadin) for two doses and go to ED to receive IV Vitamin K. Continue taking warfarin (Coumadin), but decrease daily dose to 2.5 mg while on clarithromycin (Biaxin).

Reference no: EM133785734

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