What to do first
Warfarin: check INR and bleeding signs.
Heparin: check APTT or anti-Xa per protocol and assess for bleeding.
Both: assess gums, urine, stool, bruising, IV sites, and mental status changes.
Warfarin vs Heparin NCLEX Priority Sheet
Classic anticoagulant comparison. Know the lab, route, onset, antidote, pregnancy rule, and bridge therapy logic.
Study aid - not medical advice. Not a clinical decision tool. For NCLEX pharmacology review only.
Hold If
Warfarin: notify the provider for INR >4.0, active bleeding, INR >=9.0, or serious bleeding symptoms.
Heparin: notify the provider for supratherapeutic APTT, signs of bleeding, platelet drop, or new thrombosis while receiving heparin.
Do not independently dose vitamin K, protamine, FFP, or PCC.
Labs to Watch
Warfarin: PT/INR, commonly 2.0-3.0 for many indications; some mechanical valve contexts use higher targets.
Heparin: APTT 1.5-2.5x control or anti-Xa depending on protocol.
Both: CBC, platelet count, and bleeding assessment.
Review Details
NCLEX Review Notes
Key Differences
Warfarin: PO route, slow onset, PT/INR monitoring, vitamin K reversal as ordered, crosses placenta.
Heparin: IV/SQ route, rapid onset, APTT or anti-Xa monitoring, protamine reversal as ordered, does not cross placenta.
NCLEX memory rule: Warfarin = Watch INR. Heparin = Hurry, works fast.
Heparin: IV/SQ route, rapid onset, APTT or anti-Xa monitoring, protamine reversal as ordered, does not cross placenta.
NCLEX memory rule: Warfarin = Watch INR. Heparin = Hurry, works fast.
NCLEX Trap
Trap: a patient is on IV heparin and PO warfarin bridge therapy. Which lab do you monitor?
Answer: both. Monitor INR for warfarin and APTT/anti-Xa for heparin until bridge therapy is discontinued per protocol.
Answer: both. Monitor INR for warfarin and APTT/anti-Xa for heparin until bridge therapy is discontinued per protocol.
Bleeding and HIT
Bleeding signs: bruising, epistaxis, hematuria, melena, bleeding gums, oozing IV sites, headache, or mental status change.
HIT: heparin-specific concern. Watch platelet drop, new thrombosis, or skin necrosis at injection sites.
HIT: heparin-specific concern. Watch platelet drop, new thrombosis, or skin necrosis at injection sites.
Mini Quiz
Question: A patient on warfarin has INR 5.2 and active gum bleeding. What should the nurse do first?
Answer: hold warfarin per protocol, assess bleeding, notify the provider immediately, and anticipate ordered reversal therapy.
Answer: hold warfarin per protocol, assess bleeding, notify the provider immediately, and anticipate ordered reversal therapy.
References
Saunders Comprehensive Review for the NCLEX-RN Examination; Davis's Drug Guide for Nurses; anticoagulation guideline references and institutional nomograms.