What is the next step for a patient with an International Normalized Ratio (INR) of 2.84 and a Prothrombin Time (PT) of 30.3, who was previously on 2mg of Coumadin (warfarin) with an INR of 3.18 and PT of 34?

From the Guidelines

I recommend maintaining your current Coumadin (warfarin) dose of 2mg daily since your INR has decreased from 3.18 to 2.84, which is moving toward the typical target range of 2.0-3.0 for most conditions, as suggested by the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation 1. To ensure your levels stabilize appropriately, continue this dose and schedule another INR test in about 1 week, as recommended for patients treated with warfarin when anticoagulation is stable 1. Some key points to consider include:

• The target international normalized ratio (INR) intensity should be between 2.0 to 3.0 for patients with nonvalvular AF 1
• Monitoring for any unusual bleeding or bruising is crucial, as it could indicate your blood is too thin
• If you experience severe headaches, unusual bleeding (from gums, nose, in urine or stool), or significant bruising, seek immediate medical attention
• Consistency in vitamin K intake from foods like leafy greens can help stabilize your INR levels
• Always take warfarin at the same time each day to maintain stable levels.

From the FDA Drug Label

It is based upon the determination of an International Normalized Ratio (INR) which provides a common basis for communication of PT results and interpretations of therapeutic ranges. Intervals between subsequent PT/INR determinations should be based upon the physician’s judgment of the patient’s reliability and response to warfarin sodium tablets in order to maintain the individual within the therapeutic range

The patient's current INR is 2.84 and previous INR was 3.18 while on 2mg of Coumadin.

• The current INR is below the previous value, indicating a possible decrease in the anticoagulant effect.
• However, without knowing the target therapeutic range for this patient, it's difficult to determine the best course of action.
• Considering the information provided, no conclusion can be drawn about what to do at this time, as the target INR range and other relevant factors are not specified 2.

From the Research

Current Situation

• The current INR is 2.84 with a PT of 30.3, and the previous INR was 3.18 with a PT of 34 on 2mg Coumadin.
• The patient is currently on a stable dose of Coumadin, but the INR has decreased slightly.

Relevant Studies

• A study published in 2008 3 found that patients with stable INRs while receiving warfarin who experience a significant subtherapeutic INR value have a low risk of thromboembolism in the ensuing 90 days.
• Another study published in 2015 4 found that factors such as shorter hospital stay periods, being a male patient, concurrent infection, and new initiation of warfarin therapy on hospital admission can affect discharge INRs.
• A study published in 2003 5 found that maintaining the same warfarin dose in asymptomatic patients with an INR of ≤ 3.3 is safe, and reducing the dose for patients who have a greater INR or an increased risk of hemorrhage is recommended.

Possible Actions

• Continue the current dose of 2mg Coumadin, as the current INR is still within the therapeutic range.
• Monitor the patient's INR closely to ensure it remains within the therapeutic range.
• Consider adjusting the dose if the INR continues to decrease or if the patient experiences any symptoms of thromboembolism.
• Take into account the patient's individual factors, such as age, sex, and medical history, when making decisions about warfarin dosing, as suggested by the study published in 2015 4.