Warfarin (Edinburgh Royal Infirmary)

Prescribing Warfarin in the Outpatient Dialysis Unit – Edinburgh Royal Infirmary

1st contact

Dr Sundeep Miya Bleep 5221
2nd contact

Renal Advanced Nurse Practioners Bleep 1412
3rd contact (only if 1st or 2nd contact unavailable)

Renal Registrar on-call via RIE switchboard
  • INRs should only be checked on a Monday or Tuesday unless there are clinical concerns (eg: unusual bleeding at fistula site, prolonged nose bleeds, unusual extensive bruises, malaena etc) or when instructed by a prescriber
  • Prescriptions should be completed and communicated to patients according to the following timings:
HD Day Session INR reporting to prescriber Time to contact patient
Monday Morning Monday morning before 11.00 Monday afternoon before 16.00
Afternoon Tuesday morning before 11.00 Tuesday afternoon before 16.00
Twilight Tuesday morning before 11.00 Tuesday afternoon before 16.00
Tuesday Morning Tuesday afternoon before 11.00 Tuesday afternoon before 16.00
Afternoon Wednesday morning before 11.00 Wednesday afternoon before 16.00
Twilight Wednesday morning before 11.00 Wednesday afternoon before 16.00
  • The Yellow Warfarin book MUST be made available to the prescriber completing the prescriptions – understanding the patient’s anticoagulation history is key to safe prescribing
  • All enquiries to Renal Registrar during the out-of-hours period or in the weekend MUST be done via the Nurse In-charge of the Dialysis Unit at the time. Junior doctors should NOT be routinely contacted for warfarin prescriptions except in unsafe situations as below:
    • INR >4
    • Active bleeding
    • For sub-therapeutic INRs, please follow steps above except in the following situations where the prescriber should be contacted:
      • Patients with a metallic heart valve when INR is <2.0
      • Patients with lupus anticoagulant when INR is <1.5
      • Patients with venous thromboembolism (PE/DVT) when INR is <1.5
  • Patients with stable INRs will require less frequent monitoring. They should continue their usual warfarin dose unless it is unsafe (as described above)
  • Unnecessary INR monitoring and frequent dose changes will lead to erratic anticoagulation which may be harmful to the patient

 

Written by: Jin Hah, Clinical Pharmacist
Reviewed by: Dr Iain MacIntyre, Consultant Nephrologist
Date written: September 2018
Review date: September 2020

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