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doi: 10.1136/annrheumdis-2011-200092

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For a patient who is stabilized on warfarin, close INR monitoring is prudent if acetaminophen use at moderate to high doses (2–4 g/d) for a prolonged period is anticipated, with dose adjustments to warfarin made where appropriate.1 , 3 , 9 Some authorities recommend checking the INR around 3–5 days after the first dose of acetaminophen in those taking at least 2 g/d for at least 3 consecutive days.3 However, closer monitoring would be warranted in patients at high risk of INR fluctuations (e.g., older patients and patients taking interacting medications) or who are at high risk of bleeding (e.g., patients with a prior history of bleeding events and patients with a higher INR target of 2.5–3.5).9 Likewise, once acetaminophen is no longer indicated and discontinued, the INR will need to be followed closely, as a decrease in INR within several days is expected, potentially becoming subtherapeutic.9 In patients with bleeding complications in the setting of a supratherapeutic INR, warfarin should be interrupted and reversed as indicated with intravenous vitamin K and prothrombin complex concentrate, in addition to meticulous supportive care.1 Concomitant use of acetaminophen and warfarin is common, and the potential bleeding risk as a result of a drug–drug interaction may not be appreciated