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Warfarin counselling — GPhC CRA MCQ

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ModerateCardiovascular TherapeuticsWarfarin counsellingGPhC CRA

A patient newly taking warfarin for venous thromboembolism asks to buy ibuprofen for acute back pain. Their INR was therapeutic yesterday. What should the pharmacist advise?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: EDecline ibuprofen and choose an alternative analgesic with concurrent warfarin

Decline ibuprofen and choose an alternative analgesic with concurrent warfarin: NSAIDs increase gastrointestinal and other bleeding risk independently of INR; paracetamol is usually safer, although regular higher-dose use can also affect anticoagulation. Use low-dose ibuprofen while the INR remains within target and add proton-pump-inhibitor gastroprotection: A therapeutic INR does not prevent NSAID-related platelet and gastrointestinal bleeding. Use ibuprofen at least six hours after each warfarin dose: Separating administration does not remove the pharmacodynamic bleeding risk. Pause warfarin on each day that ibuprofen treatment is needed: Unsupervised anticoagulant interruption risks recurrent thrombosis. Use aspirin temporarily in place of warfarin during ibuprofen treatment: Aspirin does not provide equivalent VTE treatment and further increases bleeding risk.

Reference: BNF: warfarin sodium: https://bnf.nice.org.uk/drugs/warfarin-sodium/