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Part One: Warfarin Dosing Guidelines

Dosage Adjustment Algorithm

		Current Daily Dose
		2.0	5.0	7.5	10.0	12.5
INR	Warfarin Dose Adjustment*	Adjusted Daily Dose
1.0-2.0	Increase x 2 days	5.0	7.5	10.0	12.5	15.0
2.0-3.0	No change	-	-	-	-	-
3.0-6.0	Decrease x 2 days	1.25	2.5	5.0	7.5	10.0
6.0-10.0¹	Decrease x 2 days	0	1.25	2.5	5.0	7.5
10.0-18.0²	Decrease x 2 days	0	0	0	0	2.5
>18.0²	Discontinue warfarin and consider hospitalization / reversal of anticoagulation
¹ Consider oral vitamin K. 2.5-5 mg ² Oral vitamin K. 2.5-5 mg0 * Allow two days after dosage change for clotting factor equilibration. Repeat prothrombin time two days after increasing or decreasing warfarin dosage and use new guide to management (INR = International Normalized Ratio). After increase or decrease or dose for two days, go to new higher (or lower) dosage level (e.g., if 5.0 qd, alternate 5.0/7.5; if alternate 2.5/5.0, increase to 5.0 qd.

Notes:

This shows a dosage adjustment algorithm which has been used successfully in an anticoagulation clinic.

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Contents

About this presentation:

The content of these pages is from a presentation called "Management of Oral Anticoagulant Therapy: Principles & Practice," prepared by the American Heart Association's Post-Graduate Education Committee of the Council on Clinical Cardiology. Supported by an educational grant from DuPont Pharmaceuticals.

Authors: Jack Ansell, M.D., Jack Hirsch, M.D., Nanette K. Wenger, M.D.

Data current as of October 1999.

Endorsed by the Anticoagulation Forum and the American Heart Association Council on Atherosclerosis, Thrombosis, and Vascular Biology.

The entire PowerPoint presentation is available from the American Heart Association.

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