Warfarin Dosing Chart
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1Contact details for advice, please ring the Anticoagulant Office on ext. 5443 / 5546
or bleep 6200 Anticoagulant Nurse
Previous Warfarin
Warfarin Dosing Chart
Maintenance dose
rd
Daily INR essential for the first 2 weeks, then every 3
day for the duration of stay,
unless change in medication or clinical circumstances.
____________mg
(
Please remember to document warfarin on the drug chart)
Pre Treatment INR
If the baseline INR > 1.2. Please contact bleep 6068 (haematology registrar)
Date
Day
INR
Dose
Doctor Prescriber
Nurse Administration
Pharmacist Screening
1
2
3
4
5
6
7
8
9
10
11
12
13
14
Prescribing and monitoring use of unfractionated heparin
(Please remember to document heparin on the drug chart)
1.
Measure APTTR at start of therapy
2. Give a 5000 units loading dose as a bolus injection IV
Date
Time
APTTR
Dose
Infusion rate
Doctor sig
Nurses sig
5000 units
Bolus IV
3. Start IV infusion, giving 15-25units/kg/hr: draw 25,000 units of unfractionated heparin into a 50mL syringe and dilute to 50mL with
sodium chloride 0.9% (resulting concentration of 500 units/mL). Start at 2mL/hr.
4. The target therapeutic range for APTTR (using synthetic reagent) is 1.5-3.5. Check APTTR 6 hours after infusion started (and after
any dose change) and adjust as follows:
APTTR
ACTION
>6
stop for 1 hr; reduce by 500 units /hr (1mL/hr)
5.3-5.9
reduce by 300 units /hr (0.6mL/hr)
4.7-5.2
reduce by 200 units /hr (0.4mL/hr)
4.1-4.6
reduce by 100 units /hr (0.2mL/hr)
3.6-4.1
reduce by 50 units /hr (0.1mL/hr)
1.5-3.5
NO CHANGE
1.2-1.4
increase by 200 units /hr (0.4mL/hr)
<1.2
increase by 400 units /hr (0.8mL/hr)
5. Repeat APTTR daily while on unfractionated heparin
6. Check platelet count 5 days after starting therapy
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