Risk Stratification for Venous Thrombosis

.Anticoagulation

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

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

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

.AF, Anticoagulant

Warfarin - drug interactions

.Anticoagulation

Acute Vestibular Syndrome vs Stroke

Original link

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 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)

Scoring:
- low risk: 0 - 2 points
- moderate risk: 3 - 4 points
- high risk: 5 or more points
.Anticoagulation