Clinical Case Database / Category: Prescribing

Prescribing warfarin: everything you need to know

Publication details

Dr Charis Costopoulos MA MBBChir
Foundation Years Journal, volume 1, issue 2, p.60 (123Doc Education, London, May 2007)


A 74-year-old retired builder presents to the medical assessment unit with a 2-day history of tiredness, weakness and dark stool. There is no history of weight loss, anorexia, dysphagia or change in bowel habit. Signifiant past medical history includes atrial fibrillation, for which he is receiving warfarin, and gastro-oesophageal reflex disease (GORD) but no previous history of peptic ulceration. Over the last 5 days he had also been receiving ciproflxacin for a presumed urinary tract infection (UTI). Examination demonstrates conjunctival pallor and melaena. Initial investigations reveal an Hb of 8.5 and an INR of 6.9. LFTs are normal.

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Dr Charis Costopoulos MA MBBChir (Corresponding author)

Academic Medicine FY2
Division of Cardiovascular Medicine
Addenbrooke’s Centre of Clinical Investigation (ACCI)
Addenbrooke’s Hospital
Cambridge, CB2 0QQ


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2.  Austin, Steve, and Forrest Batz. The A-Z Guide to Drug-Herb-Vitamin Interactions: How to Improve Your Health and Avoid Problems When Using Common Medications and Natural Supplements Together. Ed. Schulyer M. Lininger. 1st ed. New York: Three Rivers P, 1999

3.  British National Formulary. Volume 52 London: British Medical Association and the Royal pharmaceutical Society of Great Britain; 2006

4.  Alex S Gallus, Ross I Baker, Beng H Chong, Paul A Ockelford and Alison M Street on behalf of the Australasian Society of Thrombosis and Haemostasis. Consensus guidelines for warfarin therapy. MJA 2000; 172: 600-605


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T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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