A nurse is reviewing the medical history of a client who asks about the use of warfarin.
The nurse should identify which of the following findings as a contraindication for the administration of this medication?
A.
Recent myocardial infarction.
B.
Recent eye surgery.
C.
Thrombophlebitis.
D.
Breast cancer.
The Correct answer and Explanation is:
The correct answer is B. Recent eye surgery.
Explanation:
Warfarin is an anticoagulant medication that works by inhibiting the synthesis of vitamin K-dependent clotting factors in the liver. This action prevents the formation of blood clots and is commonly used to treat or prevent conditions such as deep vein thrombosis (DVT), pulmonary embolism (PE), atrial fibrillation (AF), and to prevent stroke in patients with heart conditions. While warfarin is highly effective in preventing thromboembolic events, it also increases the risk of bleeding. Therefore, it is crucial for healthcare providers to carefully assess the client’s medical history before initiating therapy.
Contraindications of Warfarin:
- Recent Eye Surgery: This is the correct answer. Eye surgeries, like cataract or glaucoma surgery, are delicate procedures where even minimal bleeding can have significant consequences, including vision loss. Because warfarin increases the risk of bleeding, administering it to someone who has recently undergone eye surgery can lead to serious complications such as intraocular hemorrhage. This could compromise the success of the surgery and the client’s vision. For this reason, recent eye surgery is a contraindication for the administration of warfarin.
- Recent Myocardial Infarction: While a myocardial infarction (heart attack) involves blood clots, warfarin may actually be prescribed after an MI to prevent further thromboembolic events, such as a stroke or another heart attack. It is not a contraindication for warfarin; rather, it might be an indication depending on the clinical scenario.
- Thrombophlebitis: This condition involves inflammation of the veins, often with associated blood clots. Warfarin is frequently used in the treatment of thrombophlebitis to prevent the clot from growing or dislodging and traveling to the lungs (which would cause a pulmonary embolism). Therefore, thrombophlebitis is not a contraindication but an indication for warfarin therapy.
- Breast Cancer: Breast cancer does not inherently increase the risk of bleeding, and it is not related to the clotting mechanism in a way that would contraindicate warfarin. Patients with breast cancer might receive anticoagulation therapy depending on their overall health and risk of thromboembolism, but the presence of breast cancer itself is not a contraindication for warfarin use.
Conclusion:
When considering the use of warfarin, it is essential to evaluate any recent surgical procedures, especially those involving areas where bleeding could lead to severe complications, such as the eyes. Recent eye surgery is a significant contraindication due to the risk of intraocular bleeding, which can severely impair vision or lead to loss of the eye. Therefore, the nurse should identify recent eye surgery as a contraindication for warfarin administration.