NAPLEX (North American Pharmacist Licensure Examination) Practice Exam

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What is the starting protocol for warfarin in patients with acute DVT/PE?

  1. Start warfarin and parenteral AC simultaneously for a minimum of 5 days and until INR is >= 2 for at least 24 hours

  2. Start warfarin only after parenteral AC has been administered for 5 days

  3. Begin with warfarin alone and monitor INR after a week

  4. Administer parenteral AC alone without warfarin for the first 5 days

The correct answer is: Start warfarin and parenteral AC simultaneously for a minimum of 5 days and until INR is >= 2 for at least 24 hours

Warfarin, an anticoagulant, is commonly used for treatment and prevention of blood clots, such as those found in deep vein thrombosis (DVT) and pulmonary embolism (PE). When starting warfarin in patients with acute DVT/PE, it is recommended to start warfarin and parenteral anticoagulants (AC) simultaneously and continue both for a minimum of 5 days. This ensures that the patient is immediately receiving anticoagulant therapy while waiting for warfarin to reach therapeutic levels. Additionally, the INR (international normalized ratio) should be monitored and be at least 2 for at least 24 hours before discontinuing the parenteral AC and continuing with warfarin alone. This regimen has been shown to be the most effective for preventing recurrent thrombotic events. Option B is incorrect because waiting 5 days before starting warfarin may put the patient at risk for further blood clots. Option C is incorrect because starting warfarin alone may not provide adequate anticoagulation therapy in the initial stages when there is a high risk for recurrent clots. Option D is incorrect because administering only parenteral AC without warfarin may not be effective