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Warfarin (Coumadin)

Vitamin K antagonist anticoagulant

Mechanism of action

Inhibits hepatic synthesis of vitamin K–dependent clotting factors (II, VII, IX, X) and proteins C and S. Onset is slow (3–5 days), so heparin is typically bridged until the INR is therapeutic. Used for long-term anticoagulation in atrial fibrillation, mechanical valves, DVT/PE, and post-stroke.

Adverse effects

Life-threatening / NCLEX-tested

  • Major bleeding — GI bleed, intracranial hemorrhage, retroperitoneal bleed
  • Hemorrhagic stroke
  • Skin necrosis (rare; occurs early, often on breasts/buttocks/thighs in protein C–deficient patients)
  • Purple toe syndrome
  • Teratogenic — absolute contraindication in pregnancy

Side effects

Common — what to teach

  • Easy bruising
  • Minor bleeding (gums, nosebleeds)
  • Heavier menstrual flow
  • Nausea, anorexia
  • Hair loss

Food & drug interactions

Many — warfarin is one of the most interaction-prone drugs in nursing. Antibiotics (especially Bactrim, metronidazole, fluconazole, macrolides), amiodarone, NSAIDs, aspirin, and SSRIs all increase bleeding risk. Vitamin K reduces effect — teach consistent, not zero, intake of green leafy vegetables (spinach, kale, broccoli). Cranberry juice and grapefruit can raise INR. Alcohol effect is dose-dependent — chronic use lowers INR, acute binge raises it.

Nursing implications

Assessment, monitoring, patient teaching

  • Monitor INR regularly; therapeutic range is 2.0–3.0 for most indications and 2.5–3.5 for mechanical mitral valves
  • Antidote is vitamin K (phytonadione); for serious bleeds use 4-factor PCC (Kcentra) or FFP
  • Teach patients consistent vitamin K intake — do not stop greens, but do not binge on them either
  • Use a soft toothbrush and electric razor; avoid contact sports
  • Report black/tarry stools, blood in urine, severe headache, or unusual bruising immediately
  • Wear a medical alert ID; carry a current med list
  • Pregnancy test before starting in women of childbearing age — warfarin is teratogenic

When to hold / contraindications

  • INR > 4.0 with no bleeding (consider holding 1–2 doses, recheck)
  • INR > 5.0 (hold and consider oral vitamin K)
  • Active bleeding from any site
  • Scheduled invasive procedure or surgery (typically held 5 days prior)
  • Confirmed or suspected pregnancy

Memory anchor

"Warfarin works on 1972" — vitamin K factors II, VII, IX, X. INR goal 2–3 (or 2.5–3.5 for mechanical valves). Antidote: vitamin K. Consistent greens, not zero greens.

Reminder: Drug cards are study aids, not clinical guidance. Always cross-check doses, holds, and contraindications with your facility's formulary and your clinical instructors before patient care.

Practice Warfarin questions

Test your recall on real NCLEX-style pharmacology questions — with full rationales and an AI Coach for the parts you miss.