Outpatient Anticoagulation Flowsheet Form

OUTPATIENT ANTICOAGULATION FLOWSHEET

Adapted from AAFP - Adjust medications only under direction of your provider

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Patient’s name: _______________________________________________ Date of birth:_____/_____/_____ Medical record #: _____________________

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Indication for anticoagulation (check one):

Atrial fibrillation

Deep vein thrombosis

Pulmonary embolism

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Mechanical valve

Cerebrovascular accident

Other

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Target International Normalized Ratio (INR)*:

2.0 to 3.0

2.5 to 3.5

Other:_____________________

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Start date: _____/_____/_____

Therapy duration:

3 months

6 months

1 year

Indefinite

Other:____________________

Date

Current dose

INR

Complications

New dose

Next INR

Initials

DOSAGE ADJUSTMENT ALGORITHMS

For target INR of 2.0 to 3.0, no bleeding:*

INR

< 1.5

1.5 to 1.9

2.0 to 3.0

3.1 to 3.9

4.0 to 4.9

≥ 5.0

Adjustment

Increase dose

Increase dose

No change

Decrease dose

Hold for 0 to 1

See reverse side.

10 to 20%;

5 to 10%

†

5 to 10%

†

day then decrease

consider extra dose

dose 10%

Next INR

4 to 8 days

7 to 14 days

No. of consecutive

7 to 14 days

4 to 8 days

See reverse side.

in-range INRs x 1

wk (max: 4 wks)

‡

For target INR of 2.5 to 3.5, no bleeding:*

INR

< 1.5

1.5 to 2.4

2.5 to 3.5

3.6 to 4.5

4.5 to 6.0

> 6.0

Adjustment

Increase dose

Increase dose

No change

Decrease dose 5

Hold for 1 to 2 days

See reverse side.

§

10 to 20%;

5 to 10%

to 10%; consider

then decrease dose

§

consider extra dose

holding one dose

5 to 15%

Next INR

4 to 8 days

7 to 14 days

No. of consecutive

7 to 14 days

2 to 8 days

See reverse side.

in-range INRs x 1

‡

wk (max: 4 wks)

* — See reverse side for further guidance.

‡ — For example, if a patient has had three consecutive in-range INR values, recheck in 3 weeks.

† — If INR is 1.8 to 1.9 or 3.1 to 3.2, consider no change with repeat

§ — If INR is 2.3 to 2.4 or 3.6 to 3.7, consider no change with repeat INR in seven to 14 days.

INR in seven to 14 days.