A client is prescribed warfarin for chronic atrial fibrillation. Which laboratory value is most concerning to the nurse?
1. Platelet count 130,000/microliter
2. Hematocrit level 31%
3. Partial thromboplastin time (PTT) 38 seconds
4. International normalized ratio (INR) 2.8
2. Hematocrit level 31%
Explanation: 1. The platelet count is not affected by warfarin and is not used to monitor the effects. This is a low platelet count but is not concerning.
2. With no other obvious cause for bleeding and no relevant history, the client on an anticoagulant should not experience anemia. This finding is concerning for the possibility of unseen bleeding. The nurse assesses for other manifestations of blood loss and ensures the healthcare provider is aware.
3. The PTT is used to monitor the effects of heparin. This value is slightly elevated and not concerning.
4. The PT, a measure of the time required for a firm fibrin clot to form after reagents have been added to the blood sample, is the standard measure of efficacy. It is commonly reported in an INR. Warfarin will prolong the INR. An INR of 2-3 is the goal for atrial fibrillation management.
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