Episode 3 is the essential practical guide to managing patients on Warfarin (Coumadin). We demystify the complex protocols with a focus on clinical decision-making.

Inside This Episode:

• INR Management Made Easy: We provide a detailed table of actions for various International Normalized Ratio (INR) ranges, offering precise instructions on when to adjust, hold, or resume dosing, and the timing for follow-up INR checks.

• Reversal Strategies: A clear, step-by-step protocol for warfarin reversal, differentiating between non-emergent INR elevation and life-threatening bleeding emergencies.

• Memory Aids & Pitfalls: Essential mnemonics and guides to help clinicians instantly recall the major factors that influence INR (including antibiotics, diet, alcohol, and herbal supplements).

• The Bridge Protocol: A comprehensive section on perioperative warfarin management, including when to stop the medication before surgery and clear criteria for initiating Low Molecular Weight Heparin (LMWH) bridging therapy based on patient risk stratification (e.g., using the CHADS_2 score).

This essential second episode of RxPlained moves from VTE risk identification to complete management strategies. We break down the comprehensive approach to Venous Thromboembolism (VTE), covering:

• Non-Drug Measures: What role do compression stockings and walking play? We discuss their primary use for symptoms and whether they truly prevent Post-Thrombotic Syndrome (PTS).

• Anticoagulation Mastery: A phase-by-phase guide to VTE treatment (acute vs. chronic). We detail the use of LMWH, Warfarin, Fondaparinux, and DOACs, including how treatment duration shifts based on factors like pregnancy or active cancer.

• Clinical Considerations: Don't miss the critical focus on drug interactions, monitoring requirements (INR, anti-Xa), and special population considerations (e.g., CKD, obesity, and pregnancy) for each anticoagulant class.

• Prophylaxis Guidelines: We wrap up with a concise overview of VTE prevention (prophylaxis) guidelines for both major orthopedic and non-orthopedic surgeries.

This essential episode provides a detailed, practical roadmap for understanding Venous Thromboembolism (VTE), which includes both Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE). We start by clearly classifying the most common risk factors, separating them into Transient (e.g., surgery, travel), Persistent (e.g., cancer, family history), and Drug-Related categories. Crucially, we outline the "Red Flag" symptoms that demand immediate medical attention (like sudden shortness of breath or persistent limb swelling). Finally, we dive into the advanced topic of Heparin-Induced Thrombocytopenia (HIT)—what to look for (a platelet drop 5-10 days post-heparin) and the critical switch to non-heparin agents like Argatroban or Rivaroxaban.