一位患有深部靜脈血栓（DVT）的病人正從肝素點滴轉換至口服 Warfarin。護理師發現醫囑要求同時給予這兩種藥物。護理師應採取哪項行動？
A client with a deep vein thrombosis (DVT) is being transitioned from a heparin drip to oral warfarin. The nurse notes that both medications are ordered to be given simultaneously. Which action should the nurse take?
- AWait for the aPTT to return to normal before starting warfarin等待活化部分凝血活酶時間（aPTT）恢復正常後再開始給予華法林
- BWithhold the warfarin and notify the physician of the error暫停給予華法林並通知醫師此處方錯誤
- CAdminister both medications as prescribed✓ 正解依醫囑同時給予兩種藥物
- DStop the heparin drip before administering the first dose of warfarin在給予第一劑華法林前停止肝素點滴
這是典型的「橋接療法」（Bridging Therapy）。Warfarin 發揮抗凝血效果需要 3 到 5 天的時間，因為它主要透過抑制維生素 K 依賴性凝血因子的合成，而現有的凝血因子需時間代謝。在 Warfarin 達到治療濃度（INR 2.0-3.0）之前，病人仍處於血栓風險中，因此必須繼續使用起效迅速的 Heparin。一旦 INR 達標，Heparin 才會被停掉。因此，同時給藥是正確且必要的臨床常規，並非錯誤（B）。D 和 A 選項會讓病人失去抗凝血保護。護理師的職責是確保病人理解這段重疊期的必要性。
This is a classic example of bridging therapy. Warfarin requires 3 to 5 days to exert its anticoagulant effect because it works by inhibiting the synthesis of vitamin K-dependent clotting factors, and existing clotting factors take time to metabolize. Before warfarin reaches the therapeutic range (INR 2.0-3.0), the client remains at risk for thrombosis, so the rapid-onset heparin must be continued. Heparin is discontinued only after INR has met goal. Therefore, simultaneous administration is correct and necessary clinical practice, not an error (B). Options D and A would leave the client without anticoagulant protection. The nurse's role is to ensure the client understands the necessity of this overlap.
在美國 NCLEX 考試中，這是一個極其常見的考點，測試對藥理動力學的理解；台灣臨床上同樣執行橋接，但護理師有時較少主動對病人解釋為何要「打針又吃藥」，這在衛教上是重點。