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Warfarin Dosing Version 2.0 /  Future versions of this program will likely contain proprietary algorithms that will support daily dosing.   This current version provides general guidelines based on the information selected below.  The responses are derived from statements found in the 6th ACCP guidelines. In many cases direct quotes are used from this valuable reference.  Recent studies confirmed the importance of initiating warfarin therapy with lower doses (eg 5mg) as opposed to older protocols which advocated higher initial dosages (7.5 - 10mg).   The previous warfarin calculator was based on a modified version of the Fennerty nomogram. What is the range of INR's I should target? Select an indication for warfarin therapy Prophylaxis of venous thrombosis (high risk surgery) Treatment of venous thrombosis (DVT) Treatment of pulmonary embolism (PE) Prevention of systemic embolism Acute myocardial infarction (AMI) Valvular Heart Disease Atrial Fibrillation Mechanical Prosthetic Valves (high risk) Bileaflet mechanical valve in aortic position Certain patients with thrombosis and the antiphospholipid syndrome Prevent recurrent MI Initial dose above 5 mg?  No Yes Does the patient have Protein C deficiency: No Yes What should I do if the patient's INR is outside the therapeutic range?    Select INR range if elevated INR above therapeutic range but less than 5.0 INR > 5.0 but less than 9.  No significant bleeding INR > 9.0 and no significant bleeding present INR > 20 and serious bleeding Life-threatening bleeding Is the patient undergoing an invasive procedure? No Yes Read the disclaimer This program is for informational purposes only This document Copyright © 2003 D.McAuley, GlobalRPh Inc. All Rights Reserved.     Recommended links Sixth ACCP Consensus Conference On Antithrombotic Therapy Warfarin Dosing U of M guidelines   also here Warfarin Therapy: Evolving Strategies in Anticoagulation Annals of Internal Medicine Warfarin Info by Al Lodwick

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