I could continue on Coumadin for quite a while longer with other cases and stories, but there is too much other cool stuff to cover. I’m going to finish up on “bridging” of anticoagulants. I wrote a little bit the other night about the unique pharmacokinetics (what the body does to the drug) of Coumadin. It does have a relatively long half-life, and takes a while to get to therapeutic dosing. Often an anticoagulant like Lovenox (enoxaparin) will be utilized for individuals at high risk of clotting in the short term setting. Many times patients will be transitioned (or bridged) to Coumadin from Lovenox. Basically what this means is a patient may be on both drugs for a few days because it takes Coumadin a significant amount of time for it to begin its clot preventing effects. A sample order may be “continue Lovenox until INR is greater than or equal to 2”. This practice can be utilized for some of the other newer anticoagulants as well when switching to Coumadin. I’ve definietly seen medication errors where a patient unintentionally received both because the Lovenox was not discontinue as ordered. I’ve got a blast from the past coming for next week! Many of you who have been with me since the start of this know what the most wonderful week of the year is! It’s coming back!!!!