What is included in long-term monitoring following the treatment for warfarin and superwarfarin toxicity?

Updated: Jan 19, 2018
  • Author: Kent R Olson, MD, FACEP; Chief Editor: David Vearrier, MD, MPH  more...
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Answer

Patients who are already on warfarin, who have had an unintentional overdose, and who are hemodynamically stable with no evidence of active bleeding can follow up with their regular source of anticoagulation care. The frequency of routine INR monitoring for patients on stable warfarin dosing may be able to be extended further than every 4 weeks, depending on future studies. [18]

With acute warfarin ingestions, discharge instructions must address the risk of rebound coagulopathy, which may occur as long as 3 days afterward. Patients need to understand the importance of completing a full course of vitamin K1. [19]

Children with acute unintentional ingestions can be discharged home with follow-up care by their pediatrician in the office or by telephone at 48 hours. Most authorities no longer recommend routine follow-up PT measurement, because the incidence of significant anticoagulation in children after accidental exposure is extremely low. [8, 20, 21]


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