Anticoagulation treatment
Warfarine is the most commonly used anticoagulant. The dose of Warfarine is 2.5 mg per tablet in China (5 mg and 3 mg are available in imported form). Warfarine should be taken daily and regularly, and should not be forgotten. It is best to take warfarin from the same pharmaceutical company and the same brand.
Warfarin should be tested regularly for prothrombin time (PT) to check its anticoagulant effect.
(1) After surgery and before discharge from the hospital, the doctor has usually adjusted the warfarin dose and prothrombin time (PT) to the appropriate range for most patients. Patients should be aware of the warfarin dose and prothrombin time they are taking. However, the prothrombin time must still be checked repeatedly after discharge to achieve stability, and the hospital where the tests are performed should ideally be fixed. PT should be tested once in 2-3 days in the early postoperative period or after changing the drug species and dose, and the interval can be gradually extended after stabilization, but we recommend weekly rechecking of coagulation index, and patients who need to take warfarin for life can plan to extend the time of testing PT under the guidance of doctors after figuring out the drug rule.
(2) The ideal prothrombin time is 1.5-2 times that of the normal control. If normal is generally 12 seconds, the patient’s should be 18-24 seconds is the most ideal. If the PT is less than 18 seconds, the dose of warfarin should be increased; if it is more than 2 times (24 seconds), the dose should be reduced; it is best to contact the doctor for changing the warfarin dose. After changing the warfarin dose, the prothrombin time must be repeatedly tested again until it is close to the desired index. The test can also be performed at the international standard ratio (PT-INR), with the ideal range of PT-INR being 2-3.
(3) Warfarin overdose can cause bleeding, and insufficient dose cannot achieve the anticoagulation effect. Based on the criteria mentioned above, there are the following ways to increase or decrease the drug: a Increase or decrease by half a tablet per day: i.e., 1.25 mg. b Increase or decrease by 1/4 tablet per day, with less adjustment than a. c Increase or decrease by half or 1/4 tablet every other day. d Increase or decrease by one tablet per day. Patients should choose the appropriate method according to their situation (prothrombin time test results and dose taken).
(4) Coagulation function is usually checked by blood draw in the morning without fasting, but warfarin medication cannot be taken in the morning of the blood draw, but can be taken after the blood draw. If the patient’s daily warfarin dosage varies, e.g., one tablet a day and one and a half tablets a day. Then the warfarin dosage for the day before the blood draw should be a small dose (i.e. one tablet).
Precautions for anticoagulation therapy
1, diet: you can eat a normal diet, but the amount of greens consumed daily should be roughly equal, too much greens will shorten the prothrombin time, too little will prolong the prothrombin time. In addition, the amount of meat consumed will also affect the stability of prothrombin time. Too much meat consumed will shorten the prothrombin time and too little will lengthen the prothrombin time, both of which will affect the stability of anticoagulation. If you want to achieve a stable drug/medication ratio, you need to reduce the patient’s diet changes, leafy greens and meat is not inedible, provided that the daily amount and variety of dishes must be stable and not change too much.
2, drugs: the anticoagulant effect of anticoagulants is affected by other drugs called interference. Such as phenobarbital, aspirin, pansentin, anti-inflammatory pain, chloramphenicol, neomycin station can enhance the anticoagulant effect; vitamin K and hemostatic drugs can weaken the anticoagulant effect. Both enhancement and weakening affect the stability of the action of anticoagulants. Therefore, should be avoided as far as possible, such as a last resort must be used when the above drugs, must be closely observed by the doctor in the process of medication, and for multiple laboratory tests, prothrombin time such as unsatisfactory should be in accordance with the aforementioned requirements, adjust the anticoagulant dose.
3.Surgery during anticoagulation.
(1) traumatic bleeding: if local or suture pressure bandage can be used to stop bleeding, do not easily stop using anticoagulants.
(2) Hemorrhage or for some reason emergency surgery is necessary: intravenous warfarin antagonist – vitamin K1 30mg can be injected. surgery is performed after 4-5 hours. If you cannot wait, you can give intravenous vitamin K1 before surgery, perform surgery in time, stop bleeding carefully during surgery, and wait for no bleeding before finishing surgery. Anticoagulation is restarted 36-72 hours after surgery in the absence of local secondary bleeding.
(3) If for some reason elective surgery is required: anticoagulants can be stopped for 2-3 days before surgery and prothrombin time can be tested and surgery performed after reaching near normal. Restart anticoagulation 36-72 hours after surgery.
4.A month before anticoagulation tablets will be taken, you should try to buy them in advance, do not interrupt anticoagulation treatment for this reason!
5.Appropriate physical activity can be done, but strenuous exercise should be avoided. As far as possible to avoid participating in trauma-prone work or activities, or cause internal bleeding serious consequences.
6, married women of childbearing age should take contraceptive measures while taking warfarin.
7, after taking anticoagulants, women generally do not increase the amount of menstruation, such as an abnormal increase, you can reduce the amount or discontinue the drug, and once the menstruation, immediately resume the original dose.
8, the daily anticoagulant should be registered in the book and fill in the prothrombin time in due course, when you go to the hospital, be sure to bring with you to the doctor for reference. Please record regularly in the form of the following table: date, warfarin dose, prothrombin time.