0 no bleeding Stop warfarin
5 – 3
Increase warfarin dose as necessary
0 or 2
Role in therapy The use of warfarin is declining with preference now being given to direct oral anticoagulants (DOACs) as first-line therapy in common anticoagulation indications, such as VTE treatment and prevention of recurrence, and stroke prevention in non-valvular atrial fibrillation (NVAF)
0 The warfarin dosing calculator serves as a great help in the Coumadin dose adjustment necessary to meet the therapeutic INR requirements
Warfarin (brand names Coumadin and Jantoven) is a prescription medication used to prevent harmful blood clots from forming or growing larger
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Amiodarone, fluconazole, metronidazole, trimethoprim-sulfamethoxazole, and many other drugs inhibit the metabolism of warfarin
The American Heart Association/American College of Cardiology/Heart Rhythm Society guidelines recommend a direct oral anticoagulant over a vitamin K antagonist, unless the patient has The 5-mg warfarin initiation algorithm is shown in Table 1, the 10-mg algorithm in Figure 1, and the relationship between INR on day 5 and the predicted final maintenance dosage of warfarin in How should you adjust her warfarin dose? According to the table at the bottom of the flow sheet, you should lower the dose 5 to 10 percent and recheck the INR in seven to 14 days
Warfarin Maintenance Dosing Protocol with INR Goal 1
1-5
5 (range: 2 to 3) Duration of therapy: Indefinite Comments: For patients with atrial fibrillation (AF) and prosthetic heart valves, target INR may be increased depending on valve type, valve position, and patient factors
5-3
3 INR units below or above the therapeutic range, continuing the current dose and retesting the INR within 7-14 days may lessen the potential for destabilizing INR control [2, 65, 66]
2 mg/kg)
Role in therapy The use of warfarin is declining with preference now being given to direct oral anticoagulants (DOACs) as first-line therapy in common anticoagulation indications, such as VTE treatment and
Coumadin/warfarin pills
The American Heart Association/American College of Cardiology/Heart Rhythm Society guidelines recommend a direct oral anticoagulant over a vitamin K
5 – 2
INR
What the evidence says To provide safe, effective care for patients receiving warfarin, practices must follow a systematic process for managing anticoagulation and adjusting
Check INR
patient with a previously stable therapeutic INR, continuing current dose or a warfarin boost dose according to the pharmacist’s clinical judgement is recommended with subsequent
International normalized ratio (INR) is the preferred test of choice for patients taking vitamin K antagonists (VKA)
Information about the patient's past warfarin dosing history will help you titrate appropriately
After prescribing warfarin, patients require education regarding the importance of regular follow-up, foods that can interact with warfarin, and when to seek medical help
INR 4
This is the proportion of treatment time that the INR is within the target therapeutic range (typically 2
3
A baseline INR must be resulted prior to the verification of the first dose of warfarin
Coumadin/warfarin pills come in different colors, and each color corresponds to a different dose ( Figure )
4 or above, without warfarin, liver function and nutrition status should be assessed and specialist advice sought regarding the Consider 500mcg po Vitamin K
Consider 2
• Get a PT/INR test in 7 days if you start, stop, or change dosage of any of the following medicines: – Any antidepressant (medicine for depression) Warfarin and other vitamin K antagonists (VKAs, also called coumarins; eg, acenocoumarol, phenprocoumon, fluindione) have been available for decades and are used in various settings
Pill size: Warfarin is a blood thinner used to treat and prevent blood clots
People who take warfarin have higher INR levels because the medication slows the time it takes blood to clot
to verification of the warfarin dose
Alternative INR goals may be chosen when bleeding risk outweighs clotting In patients who are taking warfarin, thromboembolic events and bleeding are strongly related to the time in therapeutic range (TTR)
5 for patients with mechanical mitral valve replacements)
Accordingly, it is commonly used to prevent blood clots in the circulatory system such as deep vein thrombosis and pulmonary INR 4
0 but Less than 10
Warfarin should be dosed to achieve the target INR for a specific indication
0-3
The 5-mg warfarin initiation algorithm is shown in Table 1, the 10-mg algorithm in Figure 1, and the relationship between INR on day 5 and the predicted final maintenance dosage of warfarin in The SPAF III study 31 compared the effects of combined fixed-dose warfarin and aspirin (goal INR of 1
If you return to the Web site and enter an INR value after 3 and/or 4 warfarin doses, the dose refinement is even more accurate