INR Doz Ayarı
- Varfarin doz ayarlanması için internetteki hesaplayıcılar kullanılabilir.
Warfarin Maintenance Dosing Adjustment Nomogram for INR Goal
of
2-3
----------------------------------------------------------------------------------------------------------------
Adjustment
Guidelines
A: Baseline CBC, PT/INR required prior to
continuation of warfarin therapy.
B: Assess patient compliance
and determine if any changes have been made that may impact therapy:
1) addition of interacting drugs or herbal products; 2) changes in
diet (eating/not eating) 3) changes in health status.
C: Based
on the INR results make adjustments to the current therapy based on
the ranges
below:
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INR
<
1.5
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1.)
Verify compliance (if non-compliant: resume therapy at previous
dose).
2.) If dosage adjustment needed: increase
maintenance dose by 5%- 20%*.
[* Some clinicians
recommend a 'booster dose' 1.5 to 2x the daily maintenance dose x 1 ]
3.) Return: 3 - 7
days
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INR
1.5 -
1.9
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1.)
Verify compliance (if non-compliant: resume therapy at previous
dose).
2.) [* Some clinicians recommend a 'booster dose'
1.5 to 2x the daily maintenance dose x 1 ]
3.) If dosage
adjustment needed: increase maintenance dose by 5 - 15% (use lower
end of this range for INR values close to the therapeutic range).
4.) Return: 3 - 7
days
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INR
2.0 -
3.0
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1.)
No Changes Needed
2.) Return: 4
weeks
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INR
3.1 -
3.4
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1.)
Dose adjustment usually not necessary if level is at the low end of
this range ( 3.1 - 3.2) and at least two previous levels were
therapeutic. Recheck in 3 to 7 days.
2.) Consider
decreasing dose by 5 - 10% and/or holding one dose.
3.)
Recheck in 3- 7
days.
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INR
3.5 -
3.9
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1.)
consider holding one dose.
2.) evaluate any clinical
changes that may have occurred with the patient (eating regularly, no
new medications, etc.)
3.) consider decreasing the
maintenance dose by 5 -15% depending on magnitude of the INR
elevation.
4.) Return: 1- 3
days.
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INR
4.0 - 4.9 with no significant
bleeding
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1.)
Hold warfarin until INR is within the therapeutic range.
2.)
Recommend lowering maintenance dose by 5%- 20%
3.)
Increase frequency of monitoring until problem resolved (daily
initially).
4.) (8th ACCP): If only minimally above
therapeutic range or associated with a transient causative factor, no
dose reduction may be required.
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INR
>
5.0
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1.)
Review the latest ACCP guidelines - ELEVATED INRs.
2.) Return
daily until therapeutic.
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