{"id":3862,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/difficultyinwarfarinisation\/"},"modified":"2024-03-12T08:37:54","modified_gmt":"2024-03-12T08:37:54","slug":"difficultyinwarfarinisation","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/haematology\/anticoagulation\/difficultyinwarfarinisation\/","title":{"rendered":"Difficulty in warfarinisation"},"content":{"rendered":"\n<p>This advice is for those patients who are difficult to warfarinise.<\/p>\n\n\n\n<p>&nbsp;Please:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>check medication and compliance and document that clearly in the referral<\/li>\n\n\n\n<li>ensure the patient is not taking vitamin K (e.g. Some food supplements contain vitamin K)<\/li>\n\n\n\n<li>check if the patient has had a recent large dose of vitamin K for warfarin reversal<\/li>\n\n\n\n<li>ensure dose being given is appropriate for BMI.<\/li>\n<\/ul>\n\n\n\n<p><strong>C.M &amp; L.W 31-07-23<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<p>Patients commenced on warfarin who show no increase in INR from baseline despite administration of doses of warfarin up to 15mg daily<\/p>\n\n\n\n<p>Patients who have had therapeutic INRs that are subsequently difficult to dose \u2013 in such situations check compliance (and refer only if compliance appears satisfactory), ensure dose being given appropriate for BMI<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<p>Patients who are non-compliant with their medications<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<p>Please refer via SCI Gateway to the Department of Haematology, RIE.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Primary care investigations<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>FBC<\/li>\n\n\n\n<li>U&amp;Es and LFTS<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/MEMO-re-HAEMATOLOGY-TESTS-clinically-important-information-9-Dec-2021.pdf\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/MEMO-re-HAEMATOLOGY-TESTS-clinically-important-information-9-Dec-2021.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">MEMO re HAEMATOLOGY TESTS &#8211; clinically important information 9 Dec 2021<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Antithrombotic-Guide-Adults-v4-Sept-18.pdf\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/MEMO-re-HAEMATOLOGY-TESTS-clinically-important-information-9-Dec-2021.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Antithrombotic Guide (Adults) V4 Sept 18<\/a><\/li>\n<\/ul>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>This advice is for those patients who are difficult to warfarinise. &nbsp;Please: C.M &amp; L.W 31-07-23<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":15981,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[254],"class_list":["post-3862","page","type-page","status-publish","hentry","category-difficultyinwarfarinisation"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/haematology\/coagulopathy\/difficultyinwarfarinisation\/\" rel=\"tag\">Difficulty in Warfarinisation<\/a>","rttpg_excerpt":"This advice is for those patients who are difficult to warfarinise. &nbsp;Please: C.M &amp; L.W 31-07-23","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3862","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=3862"}],"version-history":[{"count":10,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3862\/revisions"}],"predecessor-version":[{"id":18497,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3862\/revisions\/18497"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/15981"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=3862"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=3862"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}