This includes:Ī) Liaising with the primary medical team (as required)ī) Ordering of INR tests and documentation of warfarin prescriptionĬ) Entering relevant details onto the Warfarin Database pre-dischargeĭ) Provision of discharge prescription for warfarin (preferably Coumadin) with a range of tablet doses reflective of the patient’s current warfarin requirements.Į) Booking follow up appointments for CNC Anticoagulation and Haematologist reviewį) Booking relevant imaging to be performed post-discharge During inpatient admission, it is the responsibility of the Clinical Haematology Inpatient Registrar, in consultation with the Clinical Haematology Consultant on ward service, to develop the warfarin management plan for each patient.Handover on the day of, or day immediately prior to discharge may result in delay of discharge. Handover to the Clinical Haematology unit generally occurs on day 3-4, once wires and chest drains have been removed, however the Clinical Haematology team should be updated regularly regarding these patients. Hold until INR 1.5 on Day 4, the patient should be reassessed and the loading dose per kg increased based on the individual clinical need.įor patients commencing warfarin after cardiac surgery, the Cardiac surgeon is responsible for commencing warfarin and providing initial doses. The dose reductions in table below are critical to avoid "over-shooting" the target range. Subsequent loading doses are based on individual INR response. For adult patients commencing warfarin begin with a loading dose of 5mg. (For patients with liver dysfunction, severe renal impairment, post-surgical or coagulopathic reduce this to 0.1mg/kg to a maximum of 5mg, or delay initiation). alternating 3mg and 4mg daily, instead of 3.5mg daily.Īdminister 0.2mg/kg orally as a single nocte dose, up to a maximum 5mg. Many patients will require alternate day doses e.g. As such, doses should be given in whole tablet sizes. Warfarin is NOT evenly distributed within each tablet.antibiotics), or not tolerating oral, nasogastric or parenteral nutrition, the loading dose (see below) may need to be adjusted accordingly. If the patient is receiving other medications (eg.Patients with a primary cardiac indication for warfarin usually have their TTR determined by the referring cardiologist/cardiac surgeon. The following table provides common Target Therapeutic INR Ranges for specific clinical indications.Heparinoid therapy can be ceased when the INR is therapeutic for 2 consecutive days. Warfarin should be commenced whilst concurrent heparinoid (unfractionated heparin or low molecular weight heparin) therapy is being administered, in order to reduce the risk of thrombosis.
For patient receiving infant formula or other enteral feeding formulations containing Vitamin K, at least 1 hour should separate the conclusion of a feed and the administration of warfarin. For babies exclusively breast fed, supplementing feeds with one formula feed/day to provide a constant intake of Vitamin K may be required. For infants, consideration must be given to formula vs breast fed babies.Most patients require 3-5 days of warfarin before achieving a stable maintenance phase.All new patients commencing warfarin should receive Coumadin. The following table describes the available tablet strengths and their corresponding colour. Both brands of warfarin colour-code their tablets. Brands should not be used interchangeably.
There are 2 brands of warfarin, although they are distributed by the same company. Warfarin is the generic name for the most commonly used oral anticoagulant. The guideline may be modified according to individual patient requirements. All anticoagulant management within RCH occurs under the supervision and guidance of a Consultant Haematologist. This guideline is intended to inform medical and nursing staff employed within the Clinical Haematology department. Clinical Haematology: Warfarin Management Guideline
0 kommentar(er)
