High INR on warfarin
The bottom line Clarify the warfarin dose that the patient is taking, and check for co-existing problems (such as liver disease or cancer), dietary changes, and intake of alcohol and other drugs that may increase risk of bleeding or affect international normalised ratio control Urgently refer all pa...
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| Veröffentlicht in: | BMJ (Online) 2015-04, Vol.350 (apr09 14), p.h1282-h1282 |
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| container_issue | apr09 14 |
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| container_title | BMJ (Online) |
| container_volume | 350 |
| creator | Reddy, Udaya Mallepaddi, Nageswara Rao Chevassut, Timothy J |
| description | The bottom line Clarify the warfarin dose that the patient is taking, and check for co-existing problems (such as liver disease or cancer), dietary changes, and intake of alcohol and other drugs that may increase risk of bleeding or affect international normalised ratio control Urgently refer all patients with suspected intracranial or gastrointestinal bleeding to secondary care A 72 year old woman, who had been diagnosed as having recurrent deep vein thrombosis six weeks earlier, attends the practice's phlebotomy clinic for an international normalised ratio (INR) check. Compared with warfarin, both dabigatran and rivaroxaban seem to have fewer interactions with other drugs, so anticoagulant monitoring is not recommended by the manufacturers, although this advice remains controversial. [...]both drugs are contraindicated in patients with poor renal function and the pharmacological actions of these agents are irreversible in the event of bleeding. 6 |
| doi_str_mv | 10.1136/bmj.h1282 |
| format | Article |
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Compared with warfarin, both dabigatran and rivaroxaban seem to have fewer interactions with other drugs, so anticoagulant monitoring is not recommended by the manufacturers, although this advice remains controversial. [...]both drugs are contraindicated in patients with poor renal function and the pharmacological actions of these agents are irreversible in the event of bleeding. 6</description><identifier>ISSN: 0959-8138</identifier><identifier>ISSN: 1756-1833</identifier><identifier>EISSN: 1756-1833</identifier><identifier>DOI: 10.1136/bmj.h1282</identifier><identifier>PMID: 25858914</identifier><language>eng</language><publisher>England: British Medical Journal Publishing Group</publisher><subject>10-MINUTE CONSULTATION ; Alcohol ; Anticoagulants ; Anticoagulants - administration & dosage ; Anticoagulants - adverse effects ; Antifibrinolytic Agents - administration & dosage ; Blood Pressure ; Cancer ; Comorbidity ; Diet ; Dose-Response Relationship, Drug ; Drug dosages ; Endoscopy, Digestive System ; Gastrointestinal Hemorrhage - chemically induced ; Gastrointestinal Hemorrhage - diagnosis ; Head injuries ; Hospitals ; Humans ; International Normalized Ratio ; Intracranial Hemorrhages - chemically induced ; Intracranial Hemorrhages - diagnosis ; Liver diseases ; Medical History Taking ; Metabolism ; Molecular weight ; Patients ; Polypharmacy ; Preventive medicine ; Referral and Consultation ; Vitamin K - administration & dosage ; Warfarin - administration & dosage ; Warfarin - adverse effects</subject><ispartof>BMJ (Online), 2015-04, Vol.350 (apr09 14), p.h1282-h1282</ispartof><rights>BMJ Publishing Group Ltd 2015</rights><rights>Copyright BMJ Publishing Group LTD Apr 9, 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b4172-a4a16c375b94db5f5c14c5fcf823dfa085fbd4578c27b79d11938a422bc8f503</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://bmj.com/content/350/bmj.h1282.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttp://bmj.com/content/350/bmj.h1282.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,314,780,784,803,3196,23571,27924,27925,58017,58250,77472,77503</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25858914$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Reddy, Udaya</creatorcontrib><creatorcontrib>Mallepaddi, Nageswara Rao</creatorcontrib><creatorcontrib>Chevassut, Timothy J</creatorcontrib><title>High INR on warfarin</title><title>BMJ (Online)</title><addtitle>BMJ</addtitle><description>The bottom line Clarify the warfarin dose that the patient is taking, and check for co-existing problems (such as liver disease or cancer), dietary changes, and intake of alcohol and other drugs that may increase risk of bleeding or affect international normalised ratio control Urgently refer all patients with suspected intracranial or gastrointestinal bleeding to secondary care A 72 year old woman, who had been diagnosed as having recurrent deep vein thrombosis six weeks earlier, attends the practice's phlebotomy clinic for an international normalised ratio (INR) check. Compared with warfarin, both dabigatran and rivaroxaban seem to have fewer interactions with other drugs, so anticoagulant monitoring is not recommended by the manufacturers, although this advice remains controversial. [...]both drugs are contraindicated in patients with poor renal function and the pharmacological actions of these agents are irreversible in the event of bleeding. 6</description><subject>10-MINUTE CONSULTATION</subject><subject>Alcohol</subject><subject>Anticoagulants</subject><subject>Anticoagulants - administration & dosage</subject><subject>Anticoagulants - adverse effects</subject><subject>Antifibrinolytic Agents - administration & dosage</subject><subject>Blood Pressure</subject><subject>Cancer</subject><subject>Comorbidity</subject><subject>Diet</subject><subject>Dose-Response Relationship, Drug</subject><subject>Drug dosages</subject><subject>Endoscopy, Digestive System</subject><subject>Gastrointestinal Hemorrhage - chemically induced</subject><subject>Gastrointestinal Hemorrhage - diagnosis</subject><subject>Head injuries</subject><subject>Hospitals</subject><subject>Humans</subject><subject>International Normalized Ratio</subject><subject>Intracranial Hemorrhages - chemically induced</subject><subject>Intracranial Hemorrhages - diagnosis</subject><subject>Liver diseases</subject><subject>Medical History Taking</subject><subject>Metabolism</subject><subject>Molecular weight</subject><subject>Patients</subject><subject>Polypharmacy</subject><subject>Preventive medicine</subject><subject>Referral and Consultation</subject><subject>Vitamin K - administration & dosage</subject><subject>Warfarin - administration & dosage</subject><subject>Warfarin - adverse effects</subject><issn>0959-8138</issn><issn>1756-1833</issn><issn>1756-1833</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqN0M9LwzAUB_AgihtzB8GrMtCDHjrz8rtHGeqEoSC7hzRtXMu6zmRF_O_N7FQQBHN5h_fh-8gXoWPAYwAqrrO6Gi-AKLKH-iC5SEBRuo_6OOVpooCqHhqGUGGMCZUqFfwQ9QhXXKXA-uhkWr4sRg-Pz6NmNXoz3hlfro7QgTPLUAx3c4Dmd7fzyTSZPd0_TG5mScZAksQwA8JSybOU5Rl33AKz3FmnCM2dwYq7LGdcKktkJtMcIKXKMEIyqxzHdIAuu9i1b17bImx0XQZbLJdmVTRt0CCUxEQyAf-gkkSmUhbp-S9aNa1fxX9okPEJIIRGddUp65sQfOH02pe18e8asN72qmOv-rPXaM92iW1WF_m3_GoxgtMOVGHT-J-94AQLuT120e23mX_f-QAL8oO-</recordid><startdate>20150409</startdate><enddate>20150409</enddate><creator>Reddy, Udaya</creator><creator>Mallepaddi, Nageswara Rao</creator><creator>Chevassut, Timothy J</creator><general>British Medical Journal Publishing Group</general><general>BMJ Publishing Group LTD</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88I</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M2O</scope><scope>M2P</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20150409</creationdate><title>High INR on warfarin</title><author>Reddy, Udaya ; Mallepaddi, Nageswara Rao ; Chevassut, Timothy J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b4172-a4a16c375b94db5f5c14c5fcf823dfa085fbd4578c27b79d11938a422bc8f503</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>10-MINUTE CONSULTATION</topic><topic>Alcohol</topic><topic>Anticoagulants</topic><topic>Anticoagulants - administration & dosage</topic><topic>Anticoagulants - adverse effects</topic><topic>Antifibrinolytic Agents - administration & dosage</topic><topic>Blood Pressure</topic><topic>Cancer</topic><topic>Comorbidity</topic><topic>Diet</topic><topic>Dose-Response Relationship, Drug</topic><topic>Drug dosages</topic><topic>Endoscopy, Digestive System</topic><topic>Gastrointestinal Hemorrhage - chemically induced</topic><topic>Gastrointestinal Hemorrhage - diagnosis</topic><topic>Head injuries</topic><topic>Hospitals</topic><topic>Humans</topic><topic>International Normalized Ratio</topic><topic>Intracranial Hemorrhages - chemically induced</topic><topic>Intracranial Hemorrhages - diagnosis</topic><topic>Liver diseases</topic><topic>Medical History Taking</topic><topic>Metabolism</topic><topic>Molecular weight</topic><topic>Patients</topic><topic>Polypharmacy</topic><topic>Preventive medicine</topic><topic>Referral and Consultation</topic><topic>Vitamin K - administration & dosage</topic><topic>Warfarin - 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Compared with warfarin, both dabigatran and rivaroxaban seem to have fewer interactions with other drugs, so anticoagulant monitoring is not recommended by the manufacturers, although this advice remains controversial. [...]both drugs are contraindicated in patients with poor renal function and the pharmacological actions of these agents are irreversible in the event of bleeding. 6</abstract><cop>England</cop><pub>British Medical Journal Publishing Group</pub><pmid>25858914</pmid><doi>10.1136/bmj.h1282</doi><oa>free_for_read</oa></addata></record> |
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| language | eng |
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| source | MEDLINE; BMJ Journals - NESLi2; JSTOR Archive Collection A-Z Listing |
| subjects | 10-MINUTE CONSULTATION Alcohol Anticoagulants Anticoagulants - administration & dosage Anticoagulants - adverse effects Antifibrinolytic Agents - administration & dosage Blood Pressure Cancer Comorbidity Diet Dose-Response Relationship, Drug Drug dosages Endoscopy, Digestive System Gastrointestinal Hemorrhage - chemically induced Gastrointestinal Hemorrhage - diagnosis Head injuries Hospitals Humans International Normalized Ratio Intracranial Hemorrhages - chemically induced Intracranial Hemorrhages - diagnosis Liver diseases Medical History Taking Metabolism Molecular weight Patients Polypharmacy Preventive medicine Referral and Consultation Vitamin K - administration & dosage Warfarin - administration & dosage Warfarin - adverse effects |
| title | High INR on warfarin |
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