Chapter 13: Medication Management and Administration

Jon is a 59-year-old man who has been admitted to AMU with atrial fibrillation. He has been feeling faint and unwell for several days. He has been commenced on heparin. Following an ECG and echocardiogram which shows no valve problems, the doctors decide that he will need to be anticoagulated for 6 weeks before they ask him to return for a cardioversion. Jon is prescribed bisoprolol and warfarin. Asha, a student nurse, is asked to do his discharge and provides him with his tablets and a warfarin card. Jon tells Asha he can’t wait to get home and down the pub.

Questions

  • Why should Asha be concerned by Jon’s statement?
  • What should Asha’s response be?
  • What other anticoagulants are commonly used instead of Warfarin?

Answers

  • Alcohol (beverage) (in those who drink heavily) potentially decreases the anticoagulant effect of warfarin (bnf.nice.org.uk). This means that Jon may not be anticoagulated sufficiently and is at risk of blood clots due to his AF. Blood clots could lead to a stroke.
  • Asha needs to discuss Jon’s drinking habits with him to ascertain if Jon is a heavy drinker and whether he disclosed this to the doctor. It is not unusual for patients to not disclose the truth regarding alcohol use or numbers of cigarettes smoked each day either due to embarrassment or because they know they will be asked to reduce consumption. If Asha finds out that Jon is a regular heavy drinker she would need to inform Jon that she will need to let the Doctor know as he will need to be prescribed a different anticoagulant.
  • Non-vitamin K antagonist oral anticoagulants.