Follow-up

• self-monitoring ^d
• primary-care monitoring ^d
• outpatient clinic ^d 

Advise your patient 

• about the risk of bleeding, but indicate that serious bleeds are rare ^b
• most patients on warfarin feel as healthy as patients who are not ^a  
• many drugs and foods interact with warfarin and patients should check that any new medication they take is safe. ^b  

• on > 2.5 g of paracetamol a week 
• recently started warfarin-potentiating medication 
• taking more warfarin than prescribed 
  
  
• advanced cancer 
  
  
• decreased oral intake in the last week 
• acute diarrhoeal illness in the last week 

Monitor the following patients closely - they are at increased risk of having a major bleed

• high therapeutic range  ^b 
• supratherapeutic INR ( > 4.5)  ^{a b}
• recently started warfarin  ^a 
  
  
• old age  ^a 
• arterial disease  ^a 
• co-morbid conditions  ^b  (stroke, serious heart, liver or renal disease) 
• previous GI bleed  ^a 
  
  
• on NSAIDs   ^b 

• supratherapeutic INR ( > 4.0)
• previous stroke
• prosthetic heart valves
• old age 

Around half of intracranial bleeds are fatal, and few patients make a full recovery. ^a