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Warfarin high INR — GPhC CRA MCQ

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EasyCardiovascular TherapeuticsWarfarin high INRGPhC CRA

A 76-year-old man taking warfarin for atrial fibrillation presents with an INR of 6.1 from the anticoagulation clinic today. He has no bleeding but asks to buy ibuprofen gel and co-codamol for knee pain. What is the most appropriate action?

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Correct answer: C — Refer to the anticoagulation service and avoid NSAIDs

An INR of 6.1 is above the usual therapeutic range and needs management by the anticoagulation service. NSAIDs increase bleeding risk with warfarin and should be avoided unless a prescriber has assessed the risk. Aspirin would also increase bleeding risk. The pharmacist should not advise a prolonged interruption or dose doubling without specialist direction.

Reference: BNF; NICE CKS