A client is ordered 325 mg of acetylsalicylic acid (ASA) prn for headache while also receiving warfarin. What is the most appropriate action for the practical nurse to take?

A client is ordered 325 mg of acetylsalicylic acid (ASA) prn for headache while also receiving warfarin. What is the most appropriate action for the practical nurse to take?

• A. Contact the doctor for clarification of the orders.
• B. Ask the client if he has taken Aspirin before while also taking Coumadin.
• C. Contact the pharmacist about the potential drug interaction.
• D. Consult with nursing colleagues about whether to give the ASA to the client.

Answer: (A)

When a patient on warfarin is ordered a dose of aspirin for relief of headache, there is a real risk of increased bleeding. Warfarin is an anticoagulant that reduces blood clotting, and aspirin further impairs platelet function. Together, they can raise the chance of serious bleeding in the stomach, intestines, or brain. Because of that safety concern, the most appropriate action is to contact the prescriber to clarify the intention of continuing or adjusting therapy. The clinician can decide whether the aspirin is necessary, whether the dose should be changed or held, or whether an alternative pain reliever should be used, taking into account the patient’s INR and bleeding risk. Asking the patient about prior aspirin use or asking the pharmacist for information are useful steps, but they don’t address the immediate safety of issuing a new potential interaction. Consulting with nursing colleagues can be helpful for shared decisions, but the provider who wrote the orders should be the one to authorize or modify them. The key is to verify and clarify with the prescriber before administering a medication that could significantly increase bleeding risk.

When a patient on warfarin is ordered a dose of aspirin for relief of headache, there is a real risk of increased bleeding. Warfarin is an anticoagulant that reduces blood clotting, and aspirin further impairs platelet function. Together, they can raise the chance of serious bleeding in the stomach, intestines, or brain. Because of that safety concern, the most appropriate action is to contact the prescriber to clarify the intention of continuing or adjusting therapy. The clinician can decide whether the aspirin is necessary, whether the dose should be changed or held, or whether an alternative pain reliever should be used, taking into account the patient’s INR and bleeding risk.

Asking the patient about prior aspirin use or asking the pharmacist for information are useful steps, but they don’t address the immediate safety of issuing a new potential interaction. Consulting with nursing colleagues can be helpful for shared decisions, but the provider who wrote the orders should be the one to authorize or modify them. The key is to verify and clarify with the prescriber before administering a medication that could significantly increase bleeding risk.