satyaking
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A 59 yr old femlale has been placed on coumadin after being found to have had chronic atrial fibrillation.She is noted to have an INR of 5.8,is asymptomatic,and has no overt bleeding.Which of the following is the best management for the patient?
A. Transfuse with erythrocytes
B. Give Vit. K
C. Give fresh frozen plasma
D. Hold coumadin
E. Administer both vit.K & Fresh frozen plasma.
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| chemamr
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D
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| achilles
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hold coumadin
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| reet
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D
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| satyaking
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you all are right
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| cyra
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I'd have though it was B...looked it up..and it is D.
Patients with lone AF who are under 60 years of age with no other risk factors for stroke are at low risk for systemic embolism and stroke. The risks of anticoagulation in these patients outweigh the potential benefits. Patients over 60 years of age are at intermediate risk of stroke and will benefit from anticoagulation. Younger patients without heart failure or cardiac chamber dilatation who are at high risk for atherosclerosis may take aspirin in a dosage of 325 mg per day.
Heres the link ..scroll down and table 4 sums up the recommendations for anticoagulation in pts with Atrial fib(tried pasting it here...got messed up)
http://www.aafp.org/afp/980700ap/akhtar.html
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| achilles
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thanks cyra for the info...just wanted to put down a few more points...
the risk associated with such a high INR is intracranial haemorrhage. as the age of the patient increases ( >60yrs) the risk also increases and is directly proportional to the age.
in addition to increasing age of the patient, the strongest risk factors for warfarin-associated intracranial hemorrhage are poorly controlled hypertension, excessive anticoagulation and a history of cerebrovascular disease
the ideal INR range for this patient should be between 2 and 3.
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" it's not whether you get knocked down, it's whether you get up"
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| goldglory
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i too thinkits D
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| amygdalaa
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IN terms of management of high INR with warfarin use the foll are followed.
if INR <5 no bleeding- skip warfarin dose
if INR 5-9 no bleeding- temporarily stop warfarin
if INR 5-9 and active serious bleeding tranfuse fresh frozen plasma and administer vit k(it takes 5-8 hours to take effect)
This is from uw.
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