.Anticoagulation
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Wednesday, April 4, 2012
Friday, March 30, 2012
Initiating and maintainance dose of warfarin therapy
* Usually starts with 3-5mg of warfarin on D1 and D2 for non-urgent anticoagulation with no co-morbidities
Ref: Warfarin Management - A practical approach
.Anticoagulation
Ref: Warfarin Management - A practical approach
.Anticoagulation
Wednesday, March 21, 2012
Target INRs for common indications for warfarin therapy
Target INR | Disease States |
2.0 +/- 0.5 | AF, prophylaxis of stroke and other systemic embolism |
2.5 +/- 0.5 | Prophylaxis or treatment of DVT, PE, heart valve disease, arterial disease |
3.0 +/- 0.5 | Mechanical prosthetic heart valves, AMI, hypercoagulable states |
It is recommended that INR be assessed:
- every 4 wks in stable patients
- every 2 wks in less stable patients and less compliant patients
- more frequently if and when situation warrants
.Anticoagulation
Tuesday, March 20, 2012
HASBLED risk score
HASBLED | |
Use | Assess risk of bleeding in AF |
Scoring | Hypertension +1 Abnormal renal and liver fn +1 each Stroke +1 Bleeding +1 Labile INR +1 Elderly (>65yrs) +1 Drugs or alcohol +1 each |
Assessment | Score > 3 = High risk |
Saturday, March 17, 2012
Friday, March 16, 2012
Thursday, March 15, 2012
Bleeding Risk Index
Independent Risk Factors:
- Comorbid conditions (eg serious cardiac illness, renal insufficiency, poor general conditions)
- Concomitant use of heparin
- INR level
- Worsening liver dysfunction
Controlling these independent risk factors will reduce their associated risk of bleeding
Scoring:
- low risk: 0 - 2 points
- moderate risk: 3 - 4 points
- high risk: 5 or more points
.Anticoagulation
- Comorbid conditions (eg serious cardiac illness, renal insufficiency, poor general conditions)
- Concomitant use of heparin
- INR level
- Worsening liver dysfunction
Controlling these independent risk factors will reduce their associated risk of bleeding
Number of comorbid condns at start of therapy | One (+1) Two (+2) Three (+3) |
Concomitant use of heparin | Age 60-79 yrs (+2) Age 80 or more (+4) |
INR level | 2.0 - 2.9 (+1) 3.0 or more (+2) |
Worsening liver dysfunction during therapy (bilirubin rising to 4 mg/dl (68.4 umol/L) or more) | Yes (+2) |
- low risk: 0 - 2 points
- moderate risk: 3 - 4 points
- high risk: 5 or more points
.Anticoagulation
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