Warfarin on the NCLEX
Warfarin for NCLEX: INR target, vitamin K reversal, diet teaching, drug interactions, pregnancy contraindication.
Warfarin blocks vitamin K-dependent clotting factors. Slow onset, narrow therapeutic window, lots of interactions. The NCLEX hammers INR, diet, and reversal.
Action and use
Inhibits synthesis of factors II, VII, IX, X. Used for AFib stroke prevention, mechanical valves, DVT/PE.
INR target
2-3 for most indications. 2.5-3.5 for mechanical valves. Check INR regularly, every few days during titration, then weekly to monthly.
Antidote
Vitamin K (phytonadione). For active bleeding: FFP or prothrombin complex concentrate (PCC, faster).
Diet teaching
Consistent vitamin K intake, not avoidance. Large variation in leafy greens (kale, spinach, broccoli) destabilizes INR. Avoid alcohol binges, cranberry juice, grapefruit.
Contraindications
Pregnancy (teratogenic, switch to heparin/LMWH). Active bleeding. Recent stroke (relative). High fall risk (relative).
Frequently asked
INR 6, what to do?
Hold warfarin, give vitamin K. Severity of intervention depends on bleeding and INR magnitude.
Switch to DOAC?
Often considered for AFib (apixaban, rivaroxaban). Not for mechanical valves, warfarin remains standard.
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