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

Wednesday, March 21, 2012

Target INRs for common indications for warfarin therapy

Target INRDisease States
2.0 +/- 0.5AF, prophylaxis of stroke and other systemic embolism
2.5 +/- 0.5Prophylaxis or treatment of DVT, PE, heart valve disease, arterial disease
3.0 +/- 0.5Mechanical 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
UseAssess risk of bleeding in AF
ScoringHypertension  +1
Abnormal renal and liver fn  +1 each
Stroke            +1
Bleeding         +1
Labile INR     +1
Elderly (>65yrs) +1
Drugs or alcohol  +1 each
AssessmentScore > 3 = High risk
.AF, Anticoagulant

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

Number of comorbid condns at start of therapyOne (+1)
Two (+2)
Three (+3)
Concomitant use of heparinAge 60-79 yrs  (+2)
Age 80 or more (+4)
INR level2.0 - 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)
Scoring:
- low risk: 0 - 2 points
- moderate risk: 3 - 4 points
- high risk: 5 or more points
.Anticoagulation