Can you reply to this post below?

Can you reply to this post below? I recently had a patient that was on coumadin at home for a history of DVT. She had come into the hospital for black, tarry stools that had been occurring for two days. It was determined that she had esophageal varices. She had not been to her primary care physician for months and had not had her INR levels checked during this time but continued to take her coumadin at the same dosage. Her hemoglobin when she came in was 3.7g/dL. She disclosed that she drinks multiple beers nightly and a gallon of vodka every 3-4 days. Warfarin reaches its maximum plasma concentration between 2 and 6 hours as it is completely absorbed (Holford, 1986). Its elimination half-life is around 35 hours (Holford, 1986). Coumadin may not have been the correct choice of blood thinning medication for this patient. Her alcohol consumption makes it difficult to determine a correct INR (UCONN Health, n.d.) for this patient and also puts her at risk of developing esophageal varices. She was also unreliable about getting her INR levels tested. The higher-than-normal INR put her at risk of bleeding. I would have put this patient on a blood thinner that did not have a requirement of INR level monitoring. I would have also educated her on the risk of bleeding with drinking and taking a blood thinning medication. References UCONN Health. (n.d.). A patient’s guide to warfarin (Coumadin)- UCONN Health. https://health.uconn.edu>uploads>sites>2016/03 Holford, N. H. (1986). Clinical pharmacokinetics and pharmacodynamics of warfarin. Understanding the dose-effect relationship. Clinical Pharmacokinetics, 11(6), 483-504. https://doi.org/10.2165/00003088-198611060-00005 Reply SCIENCE HEALTH SCIENCE NURSING NURS 6521

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