Makomed's Weblog

Lovenox & Coumadin should transition smoothly

Posted on: August 18, 2009

Lovenox is given as prophylaxis for DVTs, especially during surgery. Since it is a blood-thinner too, Coumadin is usually withheld while I am injecting the patient with Lovenox.

Usually after the surgery coumadin is reintroduced and titrated back into the patient’s medication regimen. The doctor has to be careful, though, since too much of both medications may cause the blood to become too thin (usually an INR > 3).

At this point the physician will rely on me to supply him with a report over the phone:

  1. “What was the result of the PT/INR?” I take this test by squeezing a large drop of blood into the Hemosense machine. Remember that INR is the standardized test and is a rationalized formula taken from the value of the PT which is set to make all the results more accurate. Therefore, INR will usually have a lower numerical value. (For example, PT=49.2 and INR=4.9)
  2. “How much coumadin is the patient taking?” Don’t trust the patient. Make sure to look at the bottle and check for the frequency of the dose which may include alternating days, the strength of the dose, and if the patient has been compliant. Also know when it was restarted
  3. “When did you give the last dose of Lovenox?” This question is a trap by the doctor to see if you followed the correct timeline of his order. Lovenox is not given permanently and is usually discontinued a few days after coumadin is reintroduced. YOU HAD BETTER CHECK THE DURATION OF THE ORDER before you inject the patient with anything

All this stuff is routine, but I got lazy today and the doctor on the phone thought I was a huge dumbass. He didn’t hesitate to notify my supervisor.


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