Lois, age 54, is taking warfarin (Vitamin K antagonist, an anticoagulant) 4 mg p.o. each day following a deep vein thrombosis. Her INs have been well-maintained at 2.0 – 2.3. Today, however her IN is 4.8. On review of her history, you note that she has been taking Advil Cold (Ibuprofen, an NSAID + phenylephrine, a decongestant), an over-the-counter cold remedy regularly for the past 3 days. Other daily medications include atorvastatin (statin) 20mg and lisinopril (ACE-I) 10mg. She has been on these daily medications and dosages for several years. A careful history, physical exam, and diagnostic testing reveal no evidence of active bleeding. Given what you know about drug-drug interactions with warfarin (Vitamin K antagonist) and management of elevated INs, identify appropriate actions to take with this patient. (Choose as many of the following options as apply). • Do nothing, she is not bleeding. • Discontinue the Advil Cold medication and advise Lois that she may continue all other medications © Administer Vitamin K 5mg to reverse the anticoagulation © Hold 1-2 doses of warfarin and then resume warfarin therapy at a lower dose when IN is in range.
