🎙️ How to Counsel a Patient on Warfarin | OSCE Talk

In this episode of OSCE Talk, Peter and Matthew walk through how to counsel a patient on Warfarin, focusing on the key differences compared with DOACs such as Apixaban.

We cover when Warfarin is indicated, including mechanical heart valves, rheumatic heart disease, and antiphospholipid syndrome, before breaking down INR monitoring, dose adjustment, and practical safety advice that frequently comes up in OSCEs.

The episode emphasises a structured counselling approach, highlighting bleeding risks, drug and food interactions, pregnancy advice, and when patients should seek urgent medical attention. We also discuss reversal with vitamin K and prothrombin complex concentrate (PCC) and outline how Warfarin counselling fits into the wider anticoagulation framework.

This episode is ideal for OSCE medication counselling stations, foundation doctors, and anyone needing a clear, practical refresher on Warfarin.

• Warfarin is a vitamin K antagonist used for anticoagulation

• Common indications include mechanical heart valves, rheumatic heart disease, AF, VTE, and antiphospholipid syndrome

• Unlike DOACs, Warfarin requires regular INR monitoring

• INR targets vary depending on indication and patient risk

• Doses are adjusted frequently using different tablet strengths

• Patients should carry a Warfarin (yellow) booklet

• Major risks include bleeding, especially GI bleeding and intracranial haemorrhage

• Warfarin interacts with many medications and foods (e.g. antibiotics, NSAIDs, St John’s wort, green leafy vegetables)

• Alcohol and cranberry juice can affect INR

• Warfarin is contraindicated in pregnancy

• Reversal involves vitamin K and PCC in severe bleeding