When discontinuing heparin and starting warfarin for Mr. Cowler, what action should the nurse take?

When discontinuing heparin and starting warfarin for Mr. Cowler, what action should the nurse take?

• A. Stop the heparin and notify the pharmacy to prepare Coumadin for Mr. Cowler.
• B. Stop the heparin and give Mr. Cowler his first dose of Coumadin.
• C. Question the doctor regarding the dose of Coumadin.
• D. Question the doctor about discontinuing heparin before therapeutic levels of Coumadin are reached.

Answer: (D)

The plan to switch from heparin to warfarin requires overlapping anticoagulation because warfarin takes several days to achieve a therapeutic effect. Heparin acts immediately and its effect ends quickly when stopped, so stopping it before warfarin has reached therapeutic levels creates a window with little or no anticoagulation, increasing the risk of thrombosis. The nurse should verify with the physician how and when to discontinue heparin and ensure an appropriate bridging plan so that anticoagulation remains in place until warfarin reaches its therapeutic level (as reflected by the INR). Monitoring and adjustments are done under physician orders, with careful attention to bleeding risk and INR.

The plan to switch from heparin to warfarin requires overlapping anticoagulation because warfarin takes several days to achieve a therapeutic effect. Heparin acts immediately and its effect ends quickly when stopped, so stopping it before warfarin has reached therapeutic levels creates a window with little or no anticoagulation, increasing the risk of thrombosis. The nurse should verify with the physician how and when to discontinue heparin and ensure an appropriate bridging plan so that anticoagulation remains in place until warfarin reaches its therapeutic level (as reflected by the INR). Monitoring and adjustments are done under physician orders, with careful attention to bleeding risk and INR.