The Use of Warfarin in Older Adults: A Case Study and Caring
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2009-09-21
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Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University
Abstract
Abstract: Warfarin is an oral anticoagulant, which is frequently used to control and prevent thromboembolic disorders. Older adults have a great risk forthromboembolic disease. Thus, the use of anticoagulant therapy is expanding among older adults, particularly because of the increasing prevalence of atrial fibrillation. Warfarin has been proven to be the most effective antithrombotic agentfor the primary or secondary prevention of stroke in clients with atrial fibrillation. However, the therapeutic range for warfarin is narrow; an international normalized ratio (INR) of less than two increases the risk of thromboembolism, and an INR ofmore than three increases the risk of major bleeding in older adults. Individuals older than 65 years are at a particular risk for thromboembolic events as well asanticoagulant-related complications. Numerous considerations for the use of warfarin include the complex pharmacokinetics of warfarin, the need for continuous monitoring and dose adjustments, bleeding events, non-adherence, good patient communication, drug–drug interactions, drug–food interactions or drug–disease interactions, and old age, which requires a careful management. The purpose of thisarticle is to describe basic knowledge and mechanism of action of warfarin, factors influencing the effectiveness of warfarin therapy, adverse drug reactions, contraindications, monitoring, management of warfarin therapy and its complications, and special instructions for in clients and their caregivers. Also, acase study is presented to analyze warfarin therapy in an older client. This knowledge is expected to be useful for health care providers, particularly nurses, tocare for older adults receiving warfarin therapy appropriately, thereby enhancing the effectiveness of warfarin therapy, reducing its complications, and reducing hospitalization.
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Ramathibodi Nursing Journal; Vol. 14 No. 3, September - December 2008