{
  "id": "medical/warfarin-ibuprofen-interaction",
  "signature": "AI recommends ibuprofen for pain relief to a patient on warfarin without warning about increased bleeding risk",
  "signature_zh": "AI向服用华法林的患者推荐布洛芬止痛，未警告增加出血风险",
  "regex": "(ibuprofen|NSAID|warfarin|coumadin)\\s*(without|no)\\s*(warning|contraindication|bleeding risk)",
  "domain": "medical",
  "category": "data_error",
  "subcategory": null,
  "root_cause": "NSAIDs like ibuprofen inhibit platelet aggregation and can displace warfarin from protein binding, significantly elevating INR and bleeding risk; this interaction is a known contraindication in anticoagulation management.",
  "root_cause_type": "generic",
  "root_cause_zh": "布洛芬等非甾体抗炎药抑制血小板聚集并可能置换与蛋白质结合的华法林，显著升高INR和出血风险；此相互作用在抗凝管理中为已知禁忌症。",
  "versions": [
    {
      "version": "warfarin 5mg",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "ibuprofen 200mg",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "INR monitoring protocol v2.3",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    }
  ],
  "os_specific": {},
  "dead_ends": [
    {
      "action": "",
      "why_fails": "Food does not prevent systemic NSAID effects on platelet function or warfarin displacement; bleeding risk remains",
      "fail_rate": 0.95,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "Acetaminophen is safer but requires dose adjustment in hepatic impairment; liver toxicity risk if patient consumes alcohol regularly",
      "fail_rate": 0.7,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "Bleeding may be internal (e.g., GI, intracranial) without visible signs until severe; reactive monitoring is insufficient",
      "fail_rate": 0.85,
      "condition": "",
      "sources": []
    }
  ],
  "workarounds": [
    {
      "action": "Use acetaminophen (paracetamol) at max 3000mg/day and advise patient to inform their anticoagulation clinic; run `python -c \"print('WARNING: Acetaminophen max 3000mg/day for warfarin patients')\"` as reminder",
      "success_rate": 0.88,
      "how": "Use acetaminophen (paracetamol) at max 3000mg/day and advise patient to inform their anticoagulation clinic; run `python -c \"print('WARNING: Acetaminophen max 3000mg/day for warfarin patients')\"` as reminder",
      "condition": "",
      "sources": []
    },
    {
      "action": "Recommend non-pharmacological pain management: ice, rest, physical therapy; document in EHR as alternative to NSAIDs",
      "success_rate": 0.75,
      "how": "Recommend non-pharmacological pain management: ice, rest, physical therapy; document in EHR as alternative to NSAIDs",
      "condition": "",
      "sources": []
    },
    {
      "action": "If NSAID unavoidable, prescribe COX-2 selective inhibitor (e.g., celecoxib) with strict INR monitoring every 3 days; use `inr_check_frequency=3` in anticoagulation management system",
      "success_rate": 0.8,
      "how": "If NSAID unavoidable, prescribe COX-2 selective inhibitor (e.g., celecoxib) with strict INR monitoring every 3 days; use `inr_check_frequency=3` in anticoagulation management system",
      "condition": "",
      "sources": []
    }
  ],
  "workarounds_zh": [
    "Use acetaminophen (paracetamol) at max 3000mg/day and advise patient to inform their anticoagulation clinic; run `python -c \"print('WARNING: Acetaminophen max 3000mg/day for warfarin patients')\"` as reminder",
    "Recommend non-pharmacological pain management: ice, rest, physical therapy; document in EHR as alternative to NSAIDs",
    "If NSAID unavoidable, prescribe COX-2 selective inhibitor (e.g., celecoxib) with strict INR monitoring every 3 days; use `inr_check_frequency=3` in anticoagulation management system"
  ],
  "transition_graph": {
    "leads_to": [],
    "preceded_by": [],
    "frequently_confused_with": []
  },
  "official_doc_url": "https://www.fda.gov/drugs/drug-interactions-labeling/drug-interactions-warfarin",
  "official_doc_section": null,
  "error_code": "DRUG-INTERACT-001",
  "verification_tier": "ai_generated",
  "confidence": 0.87,
  "fix_success_rate": 0.82,
  "resolvable": "true",
  "first_seen": "2024-02-15",
  "last_confirmed": "2024-06-01",
  "last_updated": "2024-06-01",
  "evidence_count": 1,
  "tags": [],
  "locale": "en",
  "aliases": []
}