Summary Writer: Jessica Tong
Interviewee: Ed Abadir
James talks to Dr Ed Abadir on the management of warfarin.
Edward Abadir is currently a Haematology registrar at Royal Prince Alfred Hospital and Concord Hospital. He studied medicine at the University of Sydney prior to internship and completed his Residency at Royal Prince Alfred Hospital. Ed completed his Basic Physicians Training at Royal Prince Alfred Hospital in 2013.
With Dr Edward Abadir, Haematology Registrar, Royal Prince Alfred Hospital and Concord Hospital, New South Wales, Australia
Case 1 – Pre-admissions clinic: 70 year old woman to have an elective hemi-colectomy for CRCPMHx: atrial fibrillation, on warfarin
Always evaluate the risk of thrombosis vs. the risk of bleeding
Again, consider bleeding vs. thrombosis risk, with guidance from the surgeon.
Case 2 – On the ward, a patient’s CTPA shows pulmonary emboli. ED staff have commenced enoxaparin (clexane)
Note: on overtime
Do not just chart warfarin after checking the INR. Also consider the patient’s clinical status and risk of bleeding.
Most commonly, medication interactions:
Check the medication list!
The patient is in potentially life-threatening hypovolaemic shock, so the INR needs to be reduced to normal, not the therapeutic range
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