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2 edition of implementation and evaluation of a warfarin dosage protocol in orthopedic surgery patients found in the catalog.

implementation and evaluation of a warfarin dosage protocol in orthopedic surgery patients

Julie Scott

implementation and evaluation of a warfarin dosage protocol in orthopedic surgery patients

by Julie Scott

  • 287 Want to read
  • 40 Currently reading

Published .
Written in English


The Physical Object
Pagination24 p.
Number of Pages24
ID Numbers
Open LibraryOL20827298M

dose, they can be considered stable after 3 months on the same warfarin dose. D. Warfarin Dosing - NOT on Protocol. 1. All patients receiving warfarin should be managed through the anticoagulation monitoring tooland will require the “Enroll in Anticoagulation” order to both activate the episode. The following changes have been made to the BOP Anticoagulation Protocol since it was last issued in April • A new table has been added to Section 4, Heparin Products. See Table 2. Dosing of LMWHs for Treatment and Prevention. • In Section 5, Warfarin, the discussion has been expanded to include lifestyle factors and health.

Warfarin is a very individualized medication without a “standard” dose. In order to optimize the therapeutic effect and minimize complications such as bleeding, close monitoring of the degree of anticoagulation is required. During the initial stage of therapy, expect to check the INR frequently. WARFARIN CLINICIAN SUMMARY! reduction of the usual warfarin dose in patients on amiodarone, ciprofloxacin or sulfamethoxazole.3,4 4. Provide patient education on safety, monitoring, drug and food interactions. • Major regional lumbar block anesthesia or traumatic surgery resulting in File Size: KB.

Objectives: We determine the efficacy of active reversal of warfarin anticoagulation with intravenous vitamin K compared to withholding warfarin in patients requiring urgent orthopedic trauma surgery.. Design: This was a prospective cohort with immediate prehypothesis consecutive retrospective comparative case series conducted at a level 1 university hospital trauma unit. Increasingly, self-testing is an option for selected patients on warfarin therapy. The ninth edition of the American College of Chest Physicians guidelines, published in , includes a discussion ofCited by:


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Implementation and evaluation of a warfarin dosage protocol in orthopedic surgery patients by Julie Scott Download PDF EPUB FB2

Selection of Initial Warfarin Dose along indication and target range for treatment: As part of the “Warfarin Dosed per Collaborative Practice Protocol” order in the CPOE system, the practitioner will select an initial dose, warfarin indication and target range.

Fifty-three patients initiating warfarin therapy with a target INR of to were randomly allocated to receive an initial dose of 5 or 10 mg of warfarin. Subsequent doses were based on dosing. Implementation of a perioperative warfarin management protocol can expedite surgery in hip fracture patients, but did not reduce hospital stay in our cohort, possibly because of a delay in recommencing warfarin in these patients by: initiate, dose adjust and monitor warfarin therapy.

Key Practice Recommendations 1. Initial warfarin dosing should be tailored based on patient bleed risk, potential sensitivity to warfarin, indication, goal INR range, and if potential drug interactions are present. Daily warfarin dose adjustments should be based on current INR measurements and.

Implementation of a perioperative warfarin management protocol can expedite surgery in hip fracture patients, but did not reduce hospital stay in our cohort, possibly because of a delay in.

Introduction Safe management of warfarin in the inpatient setting can be challenging. At the Mayo Clinic hospitals in Rochester, Minnesota, we set out to improve the safety of warfarin management among surgical and non-surgical inpatients.

Methods A multidisciplinary team designed a pharmacist-managed warfarin protocol (PMWP) which designated warfarin dosing to inpatient Cited by: 2. GUIDELINE ON ORAL ANTICOAGULATION WITH WARFARIN This guideline is intended to be used in Derbyshire to support the Primary care led INR monitoring service commissioned in Derbyshire.

Only accredited practitioners who meet the service specification and sign up to the service level agreement should provide this Size: KB.

The VKORC1genotype is responsible for 20 to 25 percent of the variation in the required warfarin dose. The “A” haplotype group of polymorphisms is associated with a lower required warfarin dose, while patients with group “B” haplotypes require higher doses (Rieder et al., ).

Warfarin metabolism is affected by multiple factors, including diet, medications, and individual patient characteristics. As both underdosing and overdosing can increase risks to patients, several studies have attempted to develop dosing protocols.

However, few have investigated how patient weight and body mass index (BMI) affect warfarin by: Discontinue warfarin 5 days prior to surgery. Therefore, give last dose on day 6, to achieve 5 warfarin-free days if day of surgery = day 0. Check INR the day before procedure to ensure it is lower than the goal INR.

The recent trend is to change the total weekly warfarin dose (TWD) For example, if the patient is taking 5mg/ day, the weekly dose is 35mg. If the dose must be decreased by 10%, then the weekly dose should be 35 mg - mg= mg and the daily dose becomes mg/7= mg.

Table 1: Dosage Adjustments for Patients on Warfarin Maintenance. Table 2. Evaluation of Warfarin Nomogram Performance After implementation† Variable Before implementation* Weeks 1 to 4 Weeks 5 to 12 Preoperative warfarin dose (% of patients) 10 mg 41 78 66 mg 0 3 7 5 mg 9 3 7 None 50 16 20 Days on warfarin (5 to 22) (3 to 17) (1 to 22) (mean and range) INR data.

Our institution's protocol calls for a dose of warfarin the night prior to surgery to hasten achievement of a therapeutic INR postoperatively. Recently, Aynardi et al. reported that 80% of patients were subtherapeutic at the time of discharge when prescribed warfarin, using a definition of “therapeutic” to be an INR between (20).Cited by: Twenty-seven patients in the pre-protocol group (27/, %) and 40 patients in the post-protocol group ( %, 40/) were on warfarin at admission.

There was a significant reduction in the median AOT from 73 h (IQR 46–) to h (IQR 28–45) after implementation of the warfarin protocol Cited by: Warfarin Management - Adult - Ambulatory Clinical Practice Guideline Initial warfarin dosing should be tailored based on patient bleed risk, potential sensitivity to warfarin, indication, goal INR range, and if potential drug interactions Exceptions include orthopedic surgery INR goals which are recommendations provided.

Warfarin Management CPG – Ambulatory Appendix A: Warfarin Management Dosing Tool – Adult – Ambulatory. Version Created 10/28/ Warfarin Initiation Dosing Protocol (Week 1) with INR Goal Frequency of INR Monitoring After Initiation of Warfarin.

Frequency of INR Monitoring for Maintenance of Warfarin. Warfarin therapy reduces the risk of thromboembolic events and has demonstrated effectiveness for the prevention of stroke in patients with atrial fibrillation (AF).

Approximat, or 6%, of British Columbians > 65 years live with AF. 4,5 Studies have shown that warfarin therapy could reduce the risk of stroke in these patients by about 66%. 3 Approximately a third of the patients. All patients: Last dose of warfarin on day -6 pre procedure; Hold warfarin day -5 through day -1; Consider vitamin K mg PO on day -1 pre-procedure if INR > ; Resume warfarin hours post-procedure at 1 to times usual maintenance dose (decision based on post-op assessment of bleeding risk) High or Moderate: CrCl> Our patients were started on warfarin the night before surgery; whereas Aynardi et al.

began anticoagulation with warfarin the evening following surgery. This may help explain why our data shows that % of patients (64/ patients) were within target therapy range (INR ) compared to % (56/) in the study by Aynardi [ 7 ].Cited by: 1.

compared the accuracy of 10 warfarin dose prediction algo-rithms based on the pharmacogenetics. In addition, warfarin dosing algorithm for Korean patients with stroke was devel-oped to increase the quality of care for stroke patients.

MATERIALS AND METHODS Study subjects A total of patients undergoing warfarin treatment for pre. Background Adverse reactions to warfarin may be serious and can lead to hospitalisation or death.

Minimising the risk of adverse drug reactions through the intervention of community pharmacists is important for patients receiving warfarin, especially for elderly (≥ 65 years) patients living in rural areas. Objective To evaluate the impact of an intervention by community pharmacists on the Author: Slaven Falamić, Marko Lucijanić, Maja Ortner-Hadžiabdić, Srećko Marušić, Vesna Bačić-Vrca.Warfarin should be started at a dose of 5 mg per day.

Randomized trials22,23have shown that patients are more likely to have a thera-peutic INR 3 to 5 days after starting warfarin with a 5-mg dose than with a mg dose. Also, a mg dose more frequently results in supratherapeutic INR values. We recommend a lower starting dose in: • Elderly File Size: KB.Estimation of the warfarin dose with clinical and pharmacogenetic data.

N Engl J Med ; Lenzini P, Grice G, Milligan P, Gatchel S, Deych E, Eby C, Burnett R, Clohisy J, Barrack R, Gage B. Optimal initial dose adjustment of warfarin in orthopedic patients.