Table 1 indications, goals and duration of warfarin therapy 1. Measured inr dosage adjustment next inr dose, increase weekly dose by 1020%. Discontinue warfarin and start eliquis when international normalized ratio inr is warfarin maintenance dose consult tool and adjustment calculator for outpatient and inpatient settings for medical professionals. Jul 20, 2012 appropriate dosing of coumarins is difficult to establish, due to significant interindividual variability in the dose required to obtain stable anticoagulation. Its available as a generic drug and as the brandname drugs coumadin. When taken with warfarin, statins except for pravastatin can decrease warfarin requirements. Warfarin maintenance dose consult tool and adjustment calculator for outpatient and inpatient settings for medical professionals. App is intended for use solely by physicians and pharmacists that has been trained in warfarin dosage adjustment. Transfer of the care of a patient on warfarin treatment from secondary to primary care is associated with a high risk for several reasons.
Effect of a simple twostep warfarin dosing algorithm on. If you have a procedure coming up, let us know as soon as you know the date so we can discuss warfarin reversal instructions warfarin dose adjustment table dose. The following factors may necessitate a dose increase. In patients already taking eliquis apixaban at a dose of 2. A current inr must be resulted prior to the verification of a warfarin dose adjustment. The following factors may necessitate a dose reduction. Dose adjustments for pediatric patients to maintain an inr between 2 and 3 american. Apr 01, 2015 the decision to start warfarin therapy requires an assessment of its harms and benefits for each patient. This program may be useful in an outpatient or inpatient setting to help make adjustments to therapy for patients currently receiving warfarin who are no longer in the therapeutic range at admission or during a clinic visit.
Second it offers a protocol for warfarin dose adjustment depending upon inr. Use of inr for monitoring warfarin treatment best tests. Download algorithms, calculators, and other tools to help you treat hypertension. Warfarin maintenance dosing nomogram anticoagulation services. Key points warfarin should usually be started at a dose of 5 mg per. This is a health tool that estimates the warfarin maintenance dose based on. Warfarin dosing calculator to assist in making dose adjustments based on inr. A systematic approach to managing warfarin doses fpm. Warfarin dose reminder chart download in pdf format. Warfarin should be adjusted based on current inr measurements. An acenocoumarol dosing algorithm using clinical and. Initiate warfarin on day 1 or 2 of lmwh or unfractionated heparin therapy and overlap until desired inr, then discontinue heparin. Warfarin dose and inr related to genotypes of cyp2c9 and. Warfarin therapy management province of british columbia.
Warfarin maintenance dosing adjustment nomogram globalrph. The article offers a systematic approach for the management of anticoagulation and adjustment of warfarin doses. Patients on warfarin and their physicians must constantly balance the risks of bleeding and clotting. Statins, or hydroxy methylglutarylcoenzyme a reductase inhibitors, are a class of drugs that lower ldl cholesterol and may have other cardiovascular benefits. Pengguna aplikasi ini mestilah terdiri daripada pegawai perubatan dan pegawai farmasi yang telah menjalani latihan pengubahsuaian dos warfarin ini dan penggunaan aplikasi ini adalah atas risiko sendiri. This warfarin initial dose estimator is based on the international warfarin. Warfarin oral tablet is a prescription medication used to treat and prevent blood clots in the heart, lower body, and lungs.
A nice rule of thumb for dose adjustments near the target range generally works for inrs from the high 1s to low 4s. The american college of chest physicians accp, american heart association. Warfarin therapy reduces the risk of thromboembolic events and has demonstrated effectiveness for the prevention of stroke in patients with atrial fibrillation af. Input inr and total weekly dose on a slide, and voilayou get a daily dose range, a dose change range, and a weekly dose range to help you calculate the best dose possible for your patient. The algorithm recommends no dose change when the inr is in the therapeutic range, a 10% adjustment in the weekly dose of warfarin when two consecutive inr results are out of range by no more than 0. Appendix 19 warfarin dosage adjustment algorithm anticoagulation management is a complex process, and is susceptible to multiple patient, environmental, disease state, and medication interactions. These resources come from point of care guides on these topics in the family medicine literature as well as the 2012 accp guideline. Calculate warfarin dose adjustment calculations easier. Patients must agree to undergo regular blood tests during treatment. Dec 21, 2018 warfarin dose calculator was created by a licensed physician and makes warfarin dosing easier, especially for physicians and other healthcare providers nurse practitioners and physician assistants. This program may be useful in an outpatient or inpatient setting to help make. Warfarin dose adjustments, anticoagulation clinic uc san. Cbc should have a baseline result with rechecking a minimum of every 3 days thereafter.
Jul 20, 2012 this result is at least as clinically relevant as those obtained by similar studies with warfarin. Guideline on oral anticoagulation with warfarin this guideline is intended to be used in derbyshire to support the primary care led inr monitoring service commissioned in derbyshire. If the inr is low, consider bridging with lmwh if the patient is at high risk of a clot. Below the form you can find more instructions on different warfarin doses based on inr values and hemorrhage factors.
Baseline cbc, ptinr required prior to continuation of warfarin therapy b. Second it offers a protocol for warfarin dose adjustment depending upon inr result. The warfarin dosing calculator includes the following calculates dosages for both initial and continued dosing the initial dosing calculator utilizes 2 drop down lists representing the day of. Warfarin dose calculator was created by a licensed physician and makes warfarin dosing easier, especially for physicians and other healthcare providers nurse practitioners and physician assistants. This warfarin dosing calculator estimates the maintenance dose for patients with bleeding risk based on target inr and individual bsa and risk factors. And third is a discussion of protocols for the initiation of warfarin. We offer practical tips for safe and effective warfarin therapy, based on the practices of the anticoagulation clinic of the cleveland clinic. Anticoagevaluator app american college of cardiology. A baseline inr must be resulted prior to the verification of the first dose of warfarin. Download algorithms, calculators, and other tools to help you treat hypertension, adjust warfarin levels, and more. An evaluation of intravenous vitamin k for warfarin reversal. Your patient has been taking warfarin 5mg daily for more than 2 weeks and inr is 1. Coumadin adjustment calculator the soapnote project. Only accredited practitioners who meet the service specification and sign up to the service level agreement should provide this service.
Warfarin dosing calculator multiple nomograms globalrph. Simple dosage calculator to improve quality in anticoagulation. I was told that antibiotics like metronidazole and bactrim would require anywhere from 14 empiric warfarin dose reduction, whereas levofloxacin would require about 15% dose reduction. Discontinue warfarin and start eliquis when international normalized ratio inr is warfarin oral or parenteral to eliquis. This assessment should take into account the patients medical, social, dietary and drug history, level of education and adherence to previous therapy. Discontinue the anticoagulant other than warfarin and begin taking eliquis at the usual time of the next dose of the anticoagulant other than warfarin. Warfarin maintenance dosing nomogram anticoagulation. Assess patient compliance and determine if any changes have been made that may impact therapy. How to manage warfarin therapy australian prescriber. Appropriate dosing of coumarins is difficult to establish, due to significant interindividual variability in the dose required to obtain stable anticoagulation. Poor communication on discharge may leave the primary care clinician with inadequate information to make safe testing and dose adjustment decisions. Warfarin maintenance adjustment calculator background.
Clarithromycin although clarithromycin is a combined pgp and strong cyp3a4 inhibitor, pharmacokinetic data suggest that no dose adjustment is necessary with concomitant administration with. The decision to start warfarin therapy requires an assessment of its harms and benefits for each patient. In conclusion, the observed genotype frequencies of cyp2c9 and vkorc1 in patients with myocardial infarction are similar to those previously reported in other patient groups and healthy subjects in caucasians, as is the relation between warfarin dosage and genotypes. Download warfaringuide and enjoy it on your iphone, ipad, and ipod touch. The dose calculator can also be used to assess retrospectively the potential for. Check inr after 2 days and adjust dose according to results. Several genetic and other clinical factors have been associated with the coumarins dose, and some pharmacogeneticguided dosing algorithms for warfarin and acenocoumarol have been developed for mixed populations. The safety and efficacy of warfarin is critically dependent on maintaining the inr within the target range. Warfarin dosing guideline summary warfarin coumadin is a vitamin k antagonist used to treat a number of hypercoagulable disease states.
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