Warfarin : INR not not in the therapeutic range triage

The management of patients with an International Normalized Ratio (INR) that falls outside the therapeutic range is a critical aspect of anticoagulation therapy, particularly for those on warfarin. The INR is a standardized measure used to assess the coagulation status of patients, and maintaining it within the therapeutic range is essential to minimize the risks of thromboembolic events and bleeding complications. When a patient's INR is found to be outside this range, it is imperative to conduct a thorough assessment to identify potential causes and implement appropriate management strategies.

First and foremost, adherence to warfarin therapy must be evaluated. Non-adherence can lead to significant fluctuations in INR levels, resulting in either sub-therapeutic or supra-therapeutic values (Türen & Turen, 2022). Factors contributing to non-adherence may include missed doses or accidental overdosing, which can be exacerbated by a lack of understanding of the medication's importance and its interactions with food and other substances (Türen & Turen, 2022). Additionally, the use of other medications, including over-the-counter products, vitamins, and herbal remedies, can significantly impact INR levels. For instance, certain herbal supplements may potentiate the effects of warfarin, while others may reduce its efficacy (Kılıç, 2017).

Furthermore, lifestyle factors such as...