A patient with a history of transient ischemic attacks (TIAs) is being treated with warfarin (Coumadin) and begins therapy with trimethoprim/sulfamethoxazole (Bactrim). Which of the following findings would most concern the nurse?
a. Thrombophlebitis
b. Increased bleeding
c. Decreased effect of the antibiotic
d. Decreased effect of warfarin
B
TMP/SMZ can intensify the effects of warfarin, therefore increased bleeding should most con-cern the nurse.
Thrombocytopenia is a concern, but thrombophlebitis is not.
Although the nurse would not like to see a decreased effect of the antibiotic, bleeding would be a greater concern.
A decreased effect of warfarin would need to be rectified, but the main concern is bleeding, es-pecially in a patient with TIAs, who may fall and bleed even more.
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