Oral Anticoagulation Chart - Warfarin Therapy
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1
2Oral Anticoagulation Chart – Warfarin Therapy
Version 1 – July 2008
Chart …. of ….
D.O.B:
Patient:
Unit Number:
Ward:
Consultant:
Current Anticoagulant clinic:
Reason for anticoagulation:
Pre-admission warfarin dose (if applicable):
mg.
Last pre-admission INR level:
Date measured:
Refer to Trust anticoagulation guidelines if
INR target range:
to
outside this range. (See section 3.2).
Intended duration of anticoagulation therapy:
Concurrent interacting medicines:
Information completed by:
Date:
Date
Prothrombin
Medication
Dose
Time Prescriber’s
Nurse’s
Ratio (INR)
(Oral
(in mg.)
Signature
Signature
Tick if
Result
tablets)
(Admin).
ordered
Warfarin
6pm
Warfarin
6pm
Warfarin
6pm
Warfarin
6pm
Warfarin
6pm
Warfarin
6pm
Warfarin
6pm
Warfarin
6pm
Warfarin
6pm
Warfarin
6pm
Warfarin
6pm
Warfarin
6pm
Warfarin
6pm
Chart continues overleaf
On discharge, please ensure this chart is faxed to the GP on the day of discharge or first thing on
Monday if discharge occurs at the weekend. Please ensure that the patient’s yellow anticoagulant
booklet if fully completed, updated as necessary, and is issued to the patient on discharge or leave.
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