Why the study?
Does a specific warfarin initiation nomogram safely achieve therapeutic INR levels in outpatients with venous thromboembolism?
Does a specific warfarin initiation nomogram safely achieve therapeutic INR levels in outpatients with venous thromboembolism?
A simplified outpatient warfarin initiation nomogram requiring INR testing on only days 3, 5, and 8 is safe and effective for achieving therapeutic anticoagulation in VTE.
Answers are grounded in this paper and cite their sources.
Supports simplified outpatient VTE nomogram with infrequent INR checks; hypothesis-generating and should not yet change practice.
Venous thromboembolism is a common medical problem. Recently, the emphasis has been on a switch to outpatient low molecular weight heparin therapy. Previous warfarin nomograms have been developed only for inpatients. We prospectively assessed a warfarin initiation nomogram in 105 consecutive outpatients; the nomogram requires International Normalized Ratio (INR) testing on only days 3, 5, and 8. Eighty-three percent had a therapeutic INR by day 5 and 98% by day 8. There were no major bleeds and only 6 instances of INR >4.5. This outpatient warfarin nomogram appears to be safe and efficacious in obtaining timely therapeutic levels of warfarin and deserves further study.
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Kovacs et al. (2002) studied this question.
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