A client with a new deep vein thrombosis has received enoxaparin and warfarin for 3 days. The INR is 1.2. Which action should the nurse anticipate?
1Stop enoxaparin now because three days of overlap completes DVT treatment.
2Continue both drugs as prescribed while the warfarin dose and INR are reassessed.✓ Correct answer
3Stop warfarin and use aspirin alone because the INR is below range.
4Hold both anticoagulants until the INR reaches 2.0 without further treatment.
Explanation
For acute DVT treatment, enoxaparin is continued for at least 5 days and until a therapeutic oral anticoagulant effect is achieved, with a target INR of 2.0 to 3.0 in the product labeling. At day 3 with an INR of 1.2, anticoagulant overlap is still required while the prescriber reassesses warfarin dosing and INR. Stopping enoxaparin early or withholding both drugs leaves the client under-anticoagulated; aspirin is not a substitute for this treatment plan.
Clinical reasoning Warfarin has a delayed therapeutic effect and initially reduces protein C before full anticoagulation is established. Enoxaparin supplies immediate anticoagulation during this transition.
Decision rule For acute DVT, maintain enoxaparin-warfarin overlap for at least 5 days and until the prescribed therapeutic INR is achieved.
Anticoagulant overlap — Concurrent parenteral and oral anticoagulation used until warfarin has produced a therapeutic anticoagulant effect.
International normalized ratio — A standardized measure of warfarin effect; the labeled DVT treatment target during overlap is 2.0 to 3.0.