Warfarin maintenance dosing nomogram
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Warfarin maintenance dosing nomogram Published on Anticoagulation Services (https://depts.washington.edu/anticoag/home) Warfarin maintenance dosing nomogram Guidelines for warfarin maintenance dosing adjustments For Goal INR 2-3 Dosing Adjustments For Goal INR 2.5-3.5 INR < 1.5 consider a booster dose of 1 ½ -2 times daily maintenance dose consider resumption of prior maintenance dose if factor causing decreased INR is transient [eg: missed warfarin dose(s)] if adosage adjustment is needed, increase maintenance dose by 10%–20% INR < 2.0 INR 1.5-1.7 consider a booster dose of 1 ½ – 2 times daily maintenance dose consider resumption of prior maintenance dose if factor causing decreased INR is considered [eg: missed warfarin dose(s)] if a dosage adjustment is needed, increase maintenance dose by 5-15% INR 2.0–2.3 INR 1.8–1.9 no dosage adjustment may be necessary if the last two INRs were in range, if there is no clear explanation for the INR to be out of range, and if in the judgment of the clinician, the INR does not represent an increased risk of thromboembolism for the patient consider a booster dose of 1 ½ – 2 times daily maintenance dose consider resumption of prior maintenance dose if factor causing decreased INR is transient [eg: missed warfarin dose(s)] if a dosage adjustment is needed, increase INR 2.3–2.4 ©2014 University of Washington Page 1 of 3
Transcript of Warfarin maintenance dosing nomogram
Warfarin maintenance dosing nomogramPublished on Anticoagulation Services(https://depts.washington.edu/anticoag/home)
Warfarin maintenance dosing nomogram Guidelines for warfarin maintenance dosing adjustments
For Goal INR 2-3 Dosing Adjustments For Goal INR 2.5-3.5
INR < 1.5 consider a booster doseof 1 ½ -2 times dailymaintenance doseconsider resumption ofprior maintenance doseif factor causingdecreased INR istransient [eg: missedwarfarin dose(s)]if adosage adjustment isneeded, increasemaintenance dose by10%–20%
INR < 2.0
INR 1.5-1.7 consider a booster doseof 1 ½ – 2 times dailymaintenance doseconsider resumption ofprior maintenance doseif factor causingdecreased INR isconsidered [eg: missedwarfarin dose(s)]if a dosage adjustment isneeded, increasemaintenance dose by5-15%
INR 2.0–2.3
INR 1.8–1.9 no dosage adjustmentmay be necessary if thelast two INRs were inrange, if there is no clearexplanation for the INRto be out of range, and ifin the judgment of theclinician, the INR doesnot represent anincreased risk ofthromboembolism for thepatientconsider a booster doseof 1 ½ – 2 times dailymaintenance doseconsider resumption ofprior maintenance doseif factor causingdecreased INR istransient [eg: missedwarfarin dose(s)]if a dosage adjustment isneeded, increase
INR 2.3–2.4
©2014 University of WashingtonPage 1 of 3
Warfarin maintenance dosing nomogramPublished on Anticoagulation Services(https://depts.washington.edu/anticoag/home)
maintenance dose by5%–10%
2.0-3.0 Desired range 2.5-3.53.1-3.2 no dosage adjustment
may be necessary if thelast two INRs were inrange, if there is no clearexplanation for the INRto be out of range, and ifin the judgment of theclinician, the INR doesnot represent anincreased risk ofhemorrhage for thepatientconsider continuation ofprior maintenance doseif factor causing elevatedINR is transient [eg:acute alcohol ingestion]if a dosage adjustment isneeded, decreasemaintenance dose by5%–10%
3.6-3.7
3.3-3.4 consider holding ½ to 1doseconsider resumption ofprior maintenance doseif factor causing elevatedINR is transient [eg:acute alcohol ingestion]if a dosage adjustment isneeded, decreasemaintenance dose by5%–10%
3.8-3.9
3.5-3.9 consider holding 1 doseConsider resumption ofprior maintenance doseif factor causing elevatedINR is transient [eg:acute alcohol ingestion]if a dosage adjustment isneeded, decreasemaintenance dose by5%–15%
4.0-4.4
> 4.0 Hold until INR < upperlimit of therapeutic rangeConsider use of minidoseoral vitamin KConsider resumption ofprior maintenance doseif factor causing elevatedINR is transient [eg:acute alcohol ingestion]if a dosage adjustment isneeded, decreasemaintenance dose by5%–15%
> 4.5
©2014 University of WashingtonPage 2 of 3
Warfarin maintenance dosing nomogramPublished on Anticoagulation Services(https://depts.washington.edu/anticoag/home)
Source URL (modified on 02/15/2018 - 08:59):https://depts.washington.edu/anticoag/home/content/warfarin-maintenance-dosing-nomogram
©2014 University of WashingtonPage 3 of 3
