Appendix 19 warfarin dosage adjustment algorithm anticoagulation management is a complex process, and is susceptible to multiple patient, environmental, disease state, and medication interactions. Poor communication on discharge may leave the primary care clinician with inadequate information to make safe testing and dose adjustment decisions. 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.
This warfarin initial dose estimator is based on the international warfarin. Includes dosage change and follow up recommendations. Warfarin should be adjusted based on current inr measurements. An acenocoumarol dosing algorithm using clinical and. Warfarin dose reminder chart download in pdf format. 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. Warfarin dosing guideline summary warfarin coumadin is a vitamin k antagonist used to treat a number of hypercoagulable disease states.
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. Its available as a generic drug and as the brandname drugs coumadin. Download warfaringuide and enjoy it on your iphone, ipad, and ipod touch. Warfarin maintenance dosing nomogram anticoagulation services. Since each patient responds differently to the same dose, frequent monitoring and individual dose adjustment is required. The iwpc algorithm was derived and validated in patients with a target inr of 2. A current inr must be resulted prior to the verification of a warfarin dose adjustment. Typical maintenance dose ranges between 2 and 10 mgday. Jul 20, 2012 this result is at least as clinically relevant as those obtained by similar studies with warfarin. This warfarin dosing calculator estimates the maintenance dose for patients with bleeding risk based on target inr and individual bsa and risk factors. Second it offers a protocol for warfarin dose adjustment depending upon inr. Warfarin maintenance dosing nomogram anticoagulation. Initiate warfarin on day 1 or 2 of lmwh or unfractionated heparin therapy and overlap until desired inr, then discontinue heparin. An evaluation of intravenous vitamin k for warfarin reversal.
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. 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. Assess patient compliance and determine if any changes have been made that may impact therapy. Apr 01, 2015 the decision to start warfarin therapy requires an assessment of its harms and benefits for each patient. This is a health tool that estimates the warfarin maintenance dose based on. Check inr after 2 days and adjust dose according to results. Your patient has been taking warfarin 5mg daily for more than 2 weeks and inr is 1. Warfarin therapy management province of british columbia. A nice rule of thumb for dose adjustments near the target range generally works for inrs from the high 1s to low 4s. This assessment should take into account the patients medical, social, dietary and drug history, level of education and adherence to previous therapy.
Patients on warfarin and their physicians must constantly balance the risks of bleeding and clotting. 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. The decision to start warfarin therapy requires an assessment of its harms and benefits for each patient. Statins, or hydroxy methylglutarylcoenzyme a reductase inhibitors, are a class of drugs that lower ldl cholesterol and may have other cardiovascular benefits. When taken with warfarin, statins except for pravastatin can decrease warfarin requirements. Discontinue the anticoagulant other than warfarin and begin taking eliquis at the usual time of the next dose of the anticoagulant other than warfarin. Key points warfarin should usually be started at a dose of 5 mg per. Only accredited practitioners who meet the service specification and sign up to the service level agreement should provide this service. Warfarin maintenance dosing adjustment nomogram globalrph. Simple dosage calculator to improve quality in anticoagulation. Warfarin dose and inr related to genotypes of cyp2c9 and. These resources come from point of care guides on these topics in the family medicine literature as well as the 2012 accp guideline. The warfarin dosing calculator estimates the warfarin maintenance dose based on patient data weight and height for body surface area, target inr for control over coagulation and based on other bleeding risk factors such as dvt or pe present or smoking.
Warfarin therapy reduces the risk of thromboembolic events and has demonstrated effectiveness for the prevention of stroke in patients with atrial fibrillation af. The dose calculator can also be used to assess retrospectively the potential for. Discontinue warfarin and start eliquis when international normalized ratio inr is warfarin oral or parenteral to eliquis. The american college of chest physicians accp, american heart association. Clarithromycin although clarithromycin is a combined pgp and strong cyp3a4 inhibitor, pharmacokinetic data suggest that no dose adjustment is necessary with concomitant administration with. And third is a discussion of protocols for the initiation of warfarin. Warfarin dose adjustments, anticoagulation clinic uc san. Welcome to, a free web site to help doctors and other clinicians begin warfarin therapy by estimating the therapeutic dose in patients new to. Table 1 indications, goals and duration of warfarin therapy 1.
The following factors may necessitate a dose increase. The article offers a systematic approach for the management of anticoagulation and adjustment of warfarin doses. Anticoagevaluator app american college of cardiology. 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. Warfarin dosing calculator multiple nomograms globalrph. The following factors may necessitate a dose reduction. Warfarin maintenance adjustment calculator background. Therefore if dose adjustment in clinical practice behaves similar to the clinical algorithm, this pharmacogenetic algorithm could better predict the needed acenocoumarol dose and prevent patients from being over or undercoagulated. How to manage warfarin therapy australian prescriber.
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. 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. Warfarin maintenance dosing adjustment nomogram for inr goal of 23. A systematic approach to managing warfarin doses fpm. Cbc should have a baseline result with rechecking a minimum of every 3 days thereafter. Coumadin adjustment calculator the soapnote project. Avoid coadministration with combined pgp and strong cyp3a4 inhibitors. We offer practical tips for safe and effective warfarin therapy, based on the practices of the anticoagulation clinic of the cleveland clinic. Transfer of the care of a patient on warfarin treatment from secondary to primary care is associated with a high risk for several reasons. Jul 20, 2012 appropriate dosing of coumarins is difficult to establish, due to significant interindividual variability in the dose required to obtain stable anticoagulation.
Download algorithms, calculators, and other tools to help you treat hypertension. In patients already taking eliquis apixaban at a dose of 2. The safety and efficacy of warfarin is critically dependent on maintaining the inr within the target range. Calculate warfarin dose adjustment calculations easier. Baseline cbc, ptinr required prior to continuation of warfarin therapy b. Effect of a simple twostep warfarin dosing algorithm on. Measured inr dosage adjustment next inr dose, increase weekly dose by 1020%. Warfarin oral tablet is a prescription medication used to treat and prevent blood clots in the heart, lower body, and lungs. 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. Use of inr for monitoring warfarin treatment best tests. Warfarin maintenance dose consult tool and adjustment calculator for outpatient and inpatient settings for medical professionals.
Download algorithms, calculators, and other tools to help you treat hypertension, adjust warfarin levels, and more. App is intended for use solely by physicians and pharmacists that has been trained in warfarin dosage adjustment. 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. Below the form you can find more instructions on different warfarin doses based on inr values and hemorrhage factors.
Appropriate dosing of coumarins is difficult to establish, due to significant interindividual variability in the dose required to obtain stable anticoagulation. 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. 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. Warfarin dosing calculator to assist in making dose adjustments based on inr. Patients must agree to undergo regular blood tests during treatment. A baseline inr must be resulted prior to the verification of the first dose of warfarin. If the inr is low, consider bridging with lmwh if the patient is at high risk of a clot. Dose adjustments for pediatric patients to maintain an inr between 2 and 3 american. Second it offers a protocol for warfarin dose adjustment depending upon inr result.
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